Pure motor Herpes Zoster induced brachial plexopathy

Ismail, Azza; Rao, Dasappaiah Ganesh; Sharrack, Basil

doi:10.1007/s00415-009-5149-8

Cited by 24 publications

(19 citation statements)

References 10 publications

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“…In our patient, progression of motor weakness disappeared in the first week with almost complete recovery at the end of second month. It has been previously reported that motor weakness could be resolved over a period of a few years (10). We attributed this rapid effect this expeditious effect of steroids to direct application in the inflammatory field whereby the inflammation in the affected site resolved immediately and functions rapidly returned.…”

Section: █ Discussionmentioning

confidence: 72%

“…The incidence and severity of HZ increase with age, immune system incompetency and stress (1,3,7,10,11).…”

Section: █ Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The most common complication of HZ is post-herpetic neuralgia (PHN), a syndrome characterized by neuropathic pain and allodynia in the affected region, persisting for months or even years after the rash has healed. However, motor involvement is rare, and brachial plexus neuritis is also very rare (2,3,6,7,10,11).The main components of therapy of motor paresis or neuritis due to HZ are antiviral agents, pain therapy, and physiotherapy. Some studies have showed that the use of corticosteroids in combination with antiviral agents reduces pain and accelerates the healing process (8,9,11,14).…”

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confidence: 99%

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Herpes zoster brachial plexopathy: direct steroid injection

Araz

Askin²,

Yilmaz³

2015

Turkish Neurosurgery

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ABSTRACTwhich started 2 weeks after HZ skin eruption affecting to the left C4 and C6 dermatomes. In the patient's history, the pain started with skin lesions and resolved at the end of the second weeks with oral acyclovir therapy. The patient did not define any pain at the admittance and he had no signs of cranial nerve or meningeal involvement. The skin lesions of HZ were extinguished and widely settled to periarticular region of the left shoulder, lateral surface of the left proximal arm and the left upper back. Motor strength examination of the left upper extremity revealed that motor power was 2/5 on shoulder abduction, external rotation and elbow flexion, 3/5 on elbow extension and 4/5 on wrist and fingers. There were no pathological findings except for mild hypoesthesia at the periarticular area of left shoulder.Patient's routine biochemical tests were within normal limits. Brain, diffusion-weighted brain and cervical magnetic resonance imaging (MRI) studies were normal at this time. Electrodiagnostic studies (EDS) revealed a brachial plexopathy affecting the upper, middle and lower trunks, but dominantly the upper trunk. The median, radial and ulnar nerves had slow conductivity whereas upper extremity muscles showed intensive degenerative properties in EDS. Moreover, brachial plexus MRI was performed and contrast media enhancement was observed at the left brachial plexus (Figures 1, 2).█ INTRODUCTION H erpes zoster (HZ) is a viral disease, caused by an exclusively human alpha herpes virus and is characterized by segmental painful skin rash and sensory symptoms. The most common complication of HZ is post-herpetic neuralgia (PHN), a syndrome characterized by neuropathic pain and allodynia in the affected region, persisting for months or even years after the rash has healed. However, motor involvement is rare, and brachial plexus neuritis is also very rare (2,3,6,7,10,11).The main components of therapy of motor paresis or neuritis due to HZ are antiviral agents, pain therapy, and physiotherapy. Some studies have showed that the use of corticosteroids in combination with antiviral agents reduces pain and accelerates the healing process (8,9,11,14). We present a case with motor involvement of shoulder due to HZ and its treatment with brachial plexus injection by interscalene approach with local anesthetic with low concentration and triamcinolone. █ CASE REPORTA previously healthy 69-year-old male patient was referred to our clinic with the history of progressive left arm weakness Herpes zoster (shingles) is a viral disease, characterized by painful skin eruptions and neuropathic sensory symptoms. Motor involvement and brachial plexus involvement in herpes zoster are rare conditions. Together with antiviral medication and pain therapy, palliative and supportive modalities take an important role in the treatment of herpes zoster. It is well documented in previous reports that oral or intravenous steroid administrations may be additive in management. In this case report, positive effects of direct steroid injecti...

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Section: █ Discussionmentioning

confidence: 72%

“…The incidence and severity of HZ increase with age, immune system incompetency and stress (1,3,7,10,11).…”

Section: █ Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Herpes zoster brachial plexopathy: direct steroid injection

Araz

Askin²,

Yilmaz³

2015

Turkish Neurosurgery

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“…1,2 It may also spread to involve the nerve roots adjacent to the dorsal root ganglia causing a plexitis or neuritis. 3,4 Postherpetic neuralgia is the most common complication of HZ affecting more than 40% of patients. In contrast, the motor complications of herpes zoster are rare and their true incidence is unknown.…”

mentioning

confidence: 99%

Segmental Limb Paresis Due to Zoster Plexopathy: Case Report

Arslan¹,

Uyaroğlu²,

Öcek³

et al. 2016

Turkiye Klinikleri J Neur

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68erpes zoster (HZ) is the reactivation of dormant varicella zoster virus (VZV) in the dorsal root ganglia. The commonly involved nerve segments are thoracic, lumbar and trigeminal.1,2 It may also spread to involve the nerve roots adjacent to the dorsal root ganglia causing a plexitis or neuritis.3,4 Postherpetic neuralgia is the most common complication of HZ affecting more than 40% of patients. In contrast, the motor complications of herpes zoster are rare and their true incidence is unknown. Review of the literature suggests that motor involvement occur between 1-Segmental Limb Paresis Due to Zoster Plexopathy: Case Report A AB BS S T TR RA AC CT T Segmental zoster paresis (SZP) is focal, asymmetric and a rare cause of neurogenic weakness that may occur in a limb caused by herpes zoster (HZ). It typically occurs 2-3 weeks after the herpetic rash and usually affects the myotome that corresponds to the dermatomal distribution. HZ plexopathy may be overlooked in the acute period, or the motor paresis may be mistakenly diagnosed as another cervical or lumbar pathology after the vesicular lesions have disappeared. Three zoster plexopathy cases; two brachial and one lumbar were presented in this article. Electrophysiological study (EDX) findings, limb paresis, pain and erupted skin lesions with positive VZV antibodies indicated HZ plexopathy. EDX revealed patchy involvement of brachial and lumbar plexus. Antiviral treatment and physiotherapy improved muscle strength to mild paresis. An accurate and early diagnosis is vital for total recovery of muscle strength.K Ke ey y W Wo or rd ds s: : Brachial plexus neuropathies; electromyography; herpes zoster; acyclovir; sacral plexopathy Ö ÖZ ZE ET T Segmenter zoster parezisi (SZP) fokal, asimetrik, herpes zoster (HZ) nedeniyle tek ekstremitede oluşabilen nadir bir nörojenik güçsüzlüktür. Tipik olarak herpetik döküntüden 2-3 hafta sonra meydana gelir ve genellikle dermatomal dağılıma karşılık gelen miyotomu etkiler. HZ pleksopati akut dönemde gözden kaçabilir veya lezyonlar kaybolduktan sonra motor pareziye yanlışlıkla diğer servikal ve lomber patoloji tanıları konulabilir. Bu makalede iki brakial ve bir lomber pleksopati olmak üzere üç HZ pleksopati olgusu sunuldu. Elektrofizyolojik çalışma (EDX) bulguları, ekstremite parezisi, ağrı ve kabuklanmış cilt lezyonları ile birlikte pozitif VZV antikorları HZ pleksopatiye işaret etti. EDX bulguları brakial ve lomber pleksusun yamalı tutulumu ile uyumluydu. Antiviral tedavi ve fizyoterapi tüm olgularda kas gücünü hafif pareziye geriletti. Akut fazda doğru ve erken tanı kas gücünün total geri dönüşü için gereklidir.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Brakiyal pleksus nöropatileri; elektromiyografi; herpes zoster; asiklovir; sakral pleksopati T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J N Ne eu ur r 2 20 01 16 6; ;1 11 1( (2 2)

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