Complete recovery from segmental zoster paresis confirmed by magnetic resonance imaging: A case report

Abstract

BACKGROUND Segmental zoster paresis, depending on the affected area, can present with severe clinical manifestations and render patients unable to perform activities of daily living. Therefore, it is necessary to diagnose and treat such a condition rapidly. No studies have reported using magnetic resonance imaging (MRI) to identify clinical abnormalities associated with this condition or its complete recovery. This rare case report evaluated the changes in MRI findings before and after the patient's motor symptoms recovered. CASE SUMMARY A 79-year-old woman with a history of rheumatoid arthritis and psoriasis visited the hospital for skin rashes and pain in the C5-T2 segments. The diagnosis was herpes zoster infection, and treatment was initiated. However, motor weakness suddenly occurred 14 d after the initial symptom presentation. We confirmed abnormal findings in the nerves and muscles invaded by the shingles using electromyography and MRI. After 17 mo, the patient's symptoms had completely normalized, and MRI confirmed that there were no abnormalities. CONCLUSION MRI can be a useful diagnostic modality for segmental zoster paresis and patient evaluation during recovery from motor complications.

A Report of a Case of Segmental Zoster Paresis Demonstrated by Limb Paralysis and a Review of the Literature

“…Out of the available reports, most cases of SZP occur in the immunosuppressed and the elderly, with the average age of onset at 70 years [ 6 ]. Paralysis of the affected nerve is more common in head and neck presentations, whereas weakness is most commonly seen in patients with upper extremity involvement [ 5 , 6 ]. A recent article by Liu and colleagues [ 4 ] found that SZP occurs more commonly in the upper extremities than lower extremities.…”

“…This usually occurs in the same anatomical region as the presenting rash, but the two can rarely be dissociated. Treatment usually includes antivirals, steroids, and physical therapy [ 5 ]. Early antiviral treatment improves the chances of achieving full motor recovery.…”