Segmental Zoster Paresis of Limbs

Kawajiri, Sumihiro; Tani, Momo; Noda, Kazuyuki; Fujishima, Kenji; Hattori, Nobutaka; Okuma, Yasuyuki

doi:10.1097/nrl.0b013e31811e9d6d

Cited by 55 publications

(26 citation statements)

References 24 publications

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“…Normally, MRI scanning is not performed in patients with uncomplicated zoster. A PubMed search of patients with zoster paresis (lower motor neuron weakness corresponding to the dermatome where rash was present) revealed that MRI scans are normal [1-4] or that spinal cord lesions are present 1-2 levels adjacent to the area of segmental weakness [5-7]. Thus, to our knowledge, this is the first report of widespread subclinical imaging abnormalities far beyond the site of zoster and focal zoster paresis.…”

Section: Discussionmentioning

confidence: 99%

Zoster paresis: Asymptomatic MRI lesions far beyond the site of rash and focal weakness

Tsai

Bert

Gilden

2013

Journal of the Neurological Sciences

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We describe a patient with zoster paresis and an MRI that revealed extensive spinal cord lesions from the upper cervical to the lower thoracic spinal cord. Importantly, the patient reported considerable spontaneous improvement in strength 2-3 weeks after zoster. This report reveals a previously undescribed remarkable preponderance of MRI lesions far beyond the site of zoster rash and focal lower motor neuron weakness.

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Section: Discussionmentioning

confidence: 99%

Zoster paresis: Asymptomatic MRI lesions far beyond the site of rash and focal weakness

Tsai

Bert

Gilden

2013

Journal of the Neurological Sciences

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“…Paresis of the ipsilateral shoulder or arm [473–477], occurs in 3–5% of HZ cases, but is underdiagnosed [478, 479]. Some cases are due to brachial plexopathy [480, 481], and others to Brown-Séquard hemiplegia [460, 482].…”

Section: Complicating Presentations and Disease Associationsmentioning

confidence: 99%

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

et al. 2017

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BackgroundHerpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region.MethodsWe searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines.ResultsFrom 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand.HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years – lifetime risk is approximately one-third. Average incidence of 3–10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients’ quality of life and incur heavy healthcare utilisation.ConclusionsSeveral countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2198-y) contains supplementary material, which is available to authorized users.

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“…It is usually presented as a self-limiting vesicular rash, often accompanied by post-herpetic neuralgia [ 3 ]. Though relatively rare, the virus can affect the corresponding myotome and cause motor weakness or paresis after VZV reactivation [ 4 - 6 ]. If the virus affects the lower motor nerve, the symptom may mimic sciatica or paresis caused by the lumbar spine lesion [ 7 - 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…The localization of motor abnormality can be also challenging because the involved myotomes do not always correspond to the dermatomes affected by a zoster skin rash [ 14 ]. The EMG-NCV tests have been generally used to evaluate the extent of herpes zoster-associated neuropathy [ 4 , 12 - 13 , 15 ]. However, the accuracy of those studies may vary depending on the physician’s skill and often difficult to test immediately.…”

Section: Discussionmentioning

confidence: 99%

A Case of Herpes Zoster Presented with Lower Limb Paresis

Choi

2018

Cureus

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Herpes zoster is a common viral disorder that typically shows characteristic painful skin lesion. Motor neuropathy rarely complicates herpes zoster infection, and it may be overlooked without suspicion. Here, we report a case of a herpes zoster patient who presented with sciatica and paresis, but without the typical skin lesion. The patient was initially misdiagnosed as having other disorders including trauma or spine lesion. Electrodiagnostic study and magnetic resonance imaging (MRI) helped to make an accurate diagnosis and localize the motor nerve involvement of herpes zoster.

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Segmental Zoster Paresis of Limbs

Abstract: Segmental zoster paresis is still underrecognized by neurologists. Awareness of this disorder is important because it may eliminate unnecessary invasive investigations and lead to appropriate treatment. Further studies on the treatment are necessary.

Cited by 55 publications

References 24 publications

Zoster paresis: Asymptomatic MRI lesions far beyond the site of rash and focal weakness

Zoster paresis: Asymptomatic MRI lesions far beyond the site of rash and focal weakness

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

A Case of Herpes Zoster Presented with Lower Limb Paresis

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