Unilateral diaphragmatic paralysis and segmental motor paresis following herpes zoster

Abstract

We report the case of a 73-year-old woman who complained of acute onset of pain and weakness of her left shoulder and proximal arm muscles 3 weeks after a diagnosis of herpes zoster. Electromyography revealed involvement of the C5-6 myotomes and the upper trunk of the brachial plexus. Chest X-ray and electromyographic studies documented paralysis of the left diaphragm. One year after onset, muscle strength returned to normal, but radiographic and electrophysiologic findings of diaphragm paralysis were unchanged.

Extracranial Herpetic Paresis

“…Half of the patients [47] did not recover after significant a follow-up period (1 year and more). Partial recovery was seen in significantly smaller number of patients [48], while complete recovery was present in the fewest number of patients [42].…”

“…Prognosis of these patients is generally good, and there is full recovery in almost all of them in just few months [42,43,50].…”

“…In almost all cases with a mentioned type of treatment were treated with physical therapy (24 reported patients). Some of them had other therapies: Valacyclovir 3 g/7 days (3 patients), Acyclovir 750 mg/7 days (2 patients iv and 1 per os); and Methylprednisolone 500 mg iv for 3 days (1 patient), and some of them were taking steroids [11], cervical epidural bloc [11], analgesics [42], opioids [43], Amitriptyline [43], Pregabalin [11], and Gabapentin [11].…”

Neck Pain and Dyspnea: Lessons from a Patient with Zoster

“…The acute onset and the temporal relationship between the dyspnea and the painful zoster lesions suggested that both could result from the viral inflammation of the afferent fibers travelling through C3-C5 dorsal roots, while the elevated hemi-diaphragm possibly reflected lesions of the ventral roots of the same hemi-dermatome [13]. The fact that the C3-C5 dorsal roots comprise both the afferent fibers originating in the dermatomes of the lateral neck and the ipsilateral diaphragmatic myotome could account for herpetic neck pain and contribute to the shortness of breath, respectively.…”

Herpes zoster infection complicated with diaphragmatic paralysis: rare manifestation of a common dermatological disorder

“…3 Only about 31 cases of hemi diaphragmatic paralysis associated with herpes-zoster infection have been reported previously worldwide. 1,4,5 We are reporting a case of diaphragmatic paralysis following multi dermatome herpes zoster infection.…”