Segmental Zoster Abdominal Paresis (Zoster Pseudohernia): A Review of the Literature

Abstract

Herpes zoster is a distinct clinical syndrome that may present with a segmental zoster paresis. Although thoracic dermatomes are the most commonly affected, paresis of the abdominal muscles has been less frequently reported. To review the existing published evidence regarding this unusual clinical entity, a literature search of PubMed and Google was performed. In total, 35 articles that described 36 individual cases were identified. The information from all the cases was tabulated for the analysis. The mean age was 67.5 years. The ratio of men to women was approximately 4:1. The left and right side were approximately equally affected. The most affected associated dermatome was T11. In 88.9% of the patients, the typical herpetic rash preceded the abdominal weakness. The mean latent period from rash to onset of abdominal muscle weakness was 3.5 weeks. Electrodiagnostic studies confirmed the diagnosis in 95% of the tested patients. Complete recovery with conservative measures occurred in 79.3% of the patients who were followed-up for recovery, with a mean time for recovery of 4.9 months. Visceral neuropathy co-occurred in 19.4% of the patients. Because of its self-limited nature and good prognosis, recognition of this complication is important to prevent unnecessary diagnostic studies and procedures. Electrodiagnostic studies can be effectively used to confirm the diagnosis. Because visceral neuropathy commonly co-occurs with segmental zoster abdominal paresis, it should be actively investigated and treated.

Temporary unilateral abdominal muscle paralysis due to herpes zoster without typical vesicles or pain

“…In one study, 79.3% of patients with abdominal paresis recovered completely within a year, and the mean recovery time was about 4.9 months. Unfortunately, 20.7% of these patients only partially recovered or remained paralyzed 6. Although our patient exhibited complete abdominal muscle paralysis until at least 21 days after his first visit to our hospital, the paralysis had completely resolved by 90 days after starting treatment.…”

“…However, the precise incidence of zoster sine herpete is difficult to show because of the elusive nature of this condition 5. In one study, 8% of patients with HZ‐associated abdominal muscle paralysis reportedly had no eruptions 6. Another salient characteristic of this condition is the lack of pain and sensation abnormalities.…”

“…One study reported that only one of 274 patients who were referred for hospitalization had truncal muscle paralysis 2. Moreover, several reports of zoster sine herpete have described the lack of a typical vesicular rash;3, 4, 5 one of these reports stated that 8% of patients with abdominal muscle paralysis caused by HZ had no typical rash throughout their clinical course 6. Without a typical rash, it can be difficult to differentiate diabetic truncal neuropathy as a cause of abdominal pseudohernia 7.…”

Delayed onset post-herpetic pseudohernia: a case report

“…Chernev et al documented that most patients with pseudohernia after herpes zoster eventually recover completely. 4 Unlike abdominal hernia which requires diagnostic studies and surgery, post-herpetic pseudohernia is selflimited in nature and has good prognosis hence recognition of this neurological complication of HZ is important to prevent unnecessary interventions.…”

Abdominal pseudo hernia: a rare sequelae of complicated herpes zoster

“…Because visceral neuropathy commonly co-occurs with segmental zoster abdominal paresis, it should be actively investigated and treated. 8 A nerve conduction study must be done for confirming paralysis. We can rule out morphological defects in the abdominal wall by ultrasonography, electroneuromyography can be used to confirm the axonal motor involvement.…”