Herpes Zoster Infection Complicated by Motor Paralysis

Abstract

We reviewed a total of 1,432 patients diagnosed with cutaneous herpes zoster at Hyogo College of Medicine Hospital between 1989 and 1997 for epidemiologic assessment and outcome in patients with zoster paralysis referred for rehabilitation. Of the 1,432 herpes zoster patients (624 males and 808 females, mean age 54.3 years), 12 were referred to our department of rehabilitation medicine for muscle weakness: one had myelitis, and eleven others had lower motor neuron damage. Except for one 43-year-old man with myelodysplastic syndrome, all the lower motor neuron deficit patients were over 60 years of age. Involved myotomes were more widespread than involved dermatomes in eight patients. Electromyography in four patients demonstrated denervation of involved muscles. Five patients experienced complete or near complete recovery from their muscle weakness. The muscle weakness related to herpes zoster was occasionally diagnosed by electromyography as motor neuron damage. Manifestations of motor neuron complications were not noticed but might in fact be more common than was the clinical muscle weakness.

Pure motor Herpes Zoster induced brachial plexopathy

“…They reported such EMG abnormalities in several ipsi-and contralateral segments extending both caudally and cranially. Similar findings were also reported by Akiyama although the abnormalities detected by the EMG and nerve conduction studies were most prominent in the clinically affected segments [10]. Other rare manifestations of the motor involvement in varicella zoster infections include Guillian-Barre like demyelinating polyneuritis and conduction block of the peripheral nerves manifesting as mononeuritis multiplex [7,9].…”

Unilateral diaphragmatic paralysis and segmental motor paresis following herpes zoster

“…Complete or nearly complete recovery has been reported in 50%-75% of cases. 1,11 Our patient demonstrated almost complete resolution of her sensory symptoms and motor paresis after 1 year, but diaphragmatic paralysis was unchanged. The literature suggests that prognosis in patients with diaphragmatic paralysis is not as good as it is with segmental…”

Post Herpetic C8 Myotomal Paresis

“…Involvement of limbs through spinal nerve involvement is uncommon. In the literature, Mondelli, Haanpaa and Akiyama (8,9,10) reported similar cases in series and there are a few reports from India (11,12). Myotomal paresis usually develops in the first few weeks after the onset of rash.…”