Varicella zoster presenting as cranial polyneuropathy

Niesvizky-Kogan, Itamar; Greca, Indrit; Gambhir, Harvir Singh

doi:10.1016/j.ajem.2018.12.025

Cited by 4 publications

(5 citation statements)

References 13 publications

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“…Less commonly, varicella is associated with neurological complications which can include meningitis, encephalitis, stroke (due to vasculitis of cerebral vessels) and myelitis. Neuromuscular complications are common feature of VZV reactivation, in which patients may develop neuropathies of lower cranial nerves (10) [most commonly involving the facial nerve, referred to as Ramsay-Hunt syndrome (190,191)]. VZV reactivation may also rarely resemble the clinical presentation of Elsberg syndrome (7).…”

Section: Varicella Zoster Virus (Vzv Hhv-3)mentioning

confidence: 99%

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

et al. 2022

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In this article we review complications to the peripheral nervous system that occur as a consequence of viral infections, with a special focus on complications of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). We discuss neuromuscular complications in three broad categories; the direct consequences of viral infection, autoimmune neuromuscular disorders provoked by viral infections, and chronic neurodegenerative conditions which have been associated with viral infections. We also include discussion of neuromuscular disorders that are treated by immunomodulatory therapies, and how this affects patient susceptibility in the current context of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is associated with direct consequences to the peripheral nervous system via presumed direct viral injury (dysgeusia/anosmia, myalgias/rhabdomyolysis, and potentially mononeuritis multiplex) and autoimmunity (Guillain Barré syndrome and variants). It has important implications for people receiving immunomodulatory therapies who may be at greater risk of severe outcomes from COVID-19. Thus far, chronic post-COVID syndromes (a.k.a: long COVID) also include possible involvement of the neuromuscular system. Whether we may observe neuromuscular degenerative conditions in the longer term will be an important question to monitor in future studies.

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Section: Varicella Zoster Virus (Vzv Hhv-3)mentioning

confidence: 99%

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

et al. 2022

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“…Interestingly, one patient had trigeminal ophthalmic zoster associated with oculomotor, trochlear and abducens nerve involvement. These zosters with multiple cranial nerve involvement were rarely reported in the literature [7][8][9]. We raise a hypothesis to explain the occurrence of cranial motor neuropathy in herpes zoster infection.…”

Section: Discussionmentioning

confidence: 66%

“…Rarely, herpes zoster manifests as cranial motor neuropathy, including most of the cranial nerves, which most frequent occurred in Ramsay Hunt syndrome (RHS) [5,6]. There were only a few case reports other than RHS documented in the literature [5][6][7][8][9]. Moreover, there were no systematic studies of cranial neuropathy in herpes zoster infection in terms of sensory and motor involvement in the literature.…”

Section: Introductionmentioning

confidence: 99%

Clinical Presentations and Outcome Studies of Cranial Nerve Involvement in Herpes Zoster Infection: A Retrospective Single-Center Analysis

Tsau

Liao

Hsu

et al. 2020

JCM

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Varicella-zoster virus (VZV) infection can cause chickenpox and herpes zoster. It sometimes involves cranial nerves, and rarely, it can involve multiple cranial nerves. We aimed to study clinical presentations of cranial nerve involvement in herpes zoster infection. We included patients who had the diagnosis of herpes zoster infection and cranial nerve involvement. The diagnosis was confirmed by typical vesicles and a rash. We excluded patients who had cranial neuralgias or neuropathies but without typical skin lesions (zoster sine herpete or post-herpetic neuralgia). We included 330 patients (mean age, 55.0 ± 17.0 years) who had herpes zoster with cranial nerve involvement, including 155 men and 175 women. Most frequently involved cranial nerves were the trigeminal nerve (57.9%), facial nerve (52.1%), and vestibulocochlear nerve (20.0%). Other involved cranial nerves included the glossopharyngeal nerve (0.9%), vagus nerve (0.9%), oculomotor nerve, trochlear nerve, and abducens nerve (each 0.3%, respectively). One hundred and seventy patients (51.5%) had only sensory symptoms/signs; in contrast, 160 patients (48.5%) had both sensory and motor symptoms/signs. Of those 160 patients, sensory preceded motor symptoms/signs in 64 patients (40.0%), sensory and motor symptoms/signs occurred simultaneously in 38 patients (23.8%), and motor preceded sensory symptoms/signs in 20 patients (12.5%). At one month after herpes zoster infection, vesicles and rash disappeared in 92.6% of patients; meanwhile facial palsy showed a significant improvement in 81.4% of patients (p < 0.05). Cranial motor neuropathies are not infrequent in herpes zoster infections. Multiple cranial nerve involvement frequently occurred in Ramsay Hunt syndrome. We found a significantly increased seasonal occurrence of cranial nerve zoster in spring rather than summer. Cranial motor nerves were affected while the hosts sometimes had a compromised immune system.

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“…The neurological complications of herpes zoster include postherpetic neuralgia, meningoencephalitis, myelitis, Guillain-Barre syndrome, polycranial neuritis and motor dysfunction. [9][10][11][12][13] When varicella-zoster virus invades the anterior nerve root, patients experience decreased muscle strength and motor dysfunction, which usually occurs within a few weeks after the appearance of the rash. 14 Since Broadbent first reported a case of motor dysfunction caused by cervical herpes zoster in 1866, a number of cases have been reported, [15][16][17][18] including literature reporting that the incidence of motor dysfunction in patients with herpes zoster was only 0.3%-5.0%, but Mondelli et al found that more than half of the patients with herpes zoster had limb motor nerve involvement, indicating that a large number of patients were missed.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors and Construction of a Prediction Model of Motor Dysfunction Caused by Limb Herpes Zoster

Tang¹,

Tao²,

Luo³

et al. 2022

JPR

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To analyze the influencing factors of motor dysfunction in patients with limb herpes zoster and to construct a nomogram to predict the risk of this complication. Methods: A total of 213 patients with limb herpes zoster in the First Hospital of Jiaxing from January 2015 to June 2020 were enrolled. The muscle strength of the affected limb was evaluated by the Medical Research Council (MRC) score. The muscle strength of the affected limb was less than grade 5, and lower than that of the contralateral limb (normal side) was defined as motor dysfunction. Univariate and multivariate logistic regression analyses were used to determine the influencing factors of motor dysfunction in patients with limb herpes zoster. The nomogram of the risk of motor dysfunction was drawn by R software. Discrimination and calibration of the prediction model were assessed by using the C-index and calibration plot. Internal validation was assessed by using bootstrapping validation. Results: There were 58 cases in the motor dysfunction group and 155 cases in the nonmotor dysfunction group, and univariate analysis showed that the location of involvement (OR = 4.095, 95% CI: 2.097-8.466, P = 0.017), whether or not diseases were combined (OR = 0.520, 95% CI: 0.281-0.959, P = 0.036) and the number of affected centrums (OR = 0.336, 95% CI: 0.177-0.632, P = 0.001) were associated with the occurrence of motor dysfunction in patients with limb herpes zoster. Multivariate logistic regression analysis showed that upper limb involvement (OR = 3.811, 95% CI: 1.829-8.387, P = 0.001), noncombined diseases (OR = 0.493, 95% CI: 0.249-0.969, P = 0.041) and the number of affected centrums ≤3 (OR = 0.439, 95% CI: 0.218-0.881, P = 0.020) were independent influencing factors of this complication. The prediction model displayed good discrimination with a C-index of 0.72 and good calibration. A high C-index value of 0.71 could still be reached in the interval validation. Conclusion:This study used the clinical data available to establish a nomogram model for motor dysfunction of limb herpes zoster and found that motor dysfunction is more likely to occur in patient who meets upper limb involvement, combined diseases and the number of affected centrums >3. This kind of high-risk group should be intervened as soon as possible.

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Varicella zoster presenting as cranial polyneuropathy

Cited by 4 publications

References 13 publications

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections

Clinical Presentations and Outcome Studies of Cranial Nerve Involvement in Herpes Zoster Infection: A Retrospective Single-Center Analysis

Analysis of Risk Factors and Construction of a Prediction Model of Motor Dysfunction Caused by Limb Herpes Zoster

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