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Castro LF, Atwal SA, Ramirez JM, Garza J, Lalmuanpuii J. A Report of a Case of Segmental Zoster Paresis Demonstrated by Limb Paralysis and a Review of the Literature. Cureus 2023; 15:e45691. [PMID: 37868502 PMCID: PMC10590085 DOI: 10.7759/cureus.45691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Varicella zoster virus (VZV) lies dormant in our spinal dorsal root ganglia until reactivation occurs and causes herpes zoster. VZV can spread from the dorsal root to the neighboring ventral root and cause subsequent segmental paresis. In this case report, we present the case of a 78-year-old female who was hospitalized after she developed right upper extremity paresis and altered mental status four days after the eruption of a vesicular rash involving the same dermatome. The patient received intravenous acyclovir, gabapentin, and inpatient rehabilitation. She was found to have made a full recovery one year later. Pain and a vesicular rash is the most common presentation of VZV infection in the elderly. However, segmental zoster paresis should be suspected in any patient with paralysis and a recent diagnosis of herpes zoster.
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Affiliation(s)
- Luis F Castro
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Siddharth A Atwal
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Jessica M Ramirez
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Jali Garza
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Judy Lalmuanpuii
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
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Burch SJ, Shepard E, Lipira AB. An unusual case of lower trunk brachial plexus zoster reactivation. Case Reports Plast Surg Hand Surg 2023; 10:2242497. [PMID: 37547269 PMCID: PMC10399487 DOI: 10.1080/23320885.2023.2242497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
We discuss the case of a 42-year-old woman who presented with severe left cubital tunnel neuropathic pain and subsequently developed a vesicular rash spanning the C8-T1 dermatomal distribution. These symptoms resolved after initiation of acyclovir, highlighting VZV brachial plexopathy as a potentially treatable etiology of acute onset severe neuropathic pain.
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Affiliation(s)
- Samantha J. Burch
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Elizabeth Shepard
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Angelo B. Lipira
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
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Iguchi N, Mano T, Iwasa N, Kikutsuji N, Saito K, Sugie K. An Ultrasonographic Evaluation for the Early Detection of Nerve Root Changes in Herpes Zoster-associated Motor Paresis. Intern Med 2023; 62:903-907. [PMID: 35989267 PMCID: PMC10076138 DOI: 10.2169/internalmedicine.0039-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/03/2022] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of herpes zoster complicated by right-arm paralysis, wherein cervical nerve root ultrasonography enabled the early diagnosis and a therapeutic efficacy evaluation. A 71-year-old man developed progressive weakness in the muscles innervated by the right C5-6 nerve root following the appearance of a painful rash. Cervical nerve root ultrasonography revealed C5-6 nerve root inflammatory swelling. Methylprednisolone pulse therapy and subsequent oral prednisolone therapy gradually improved the muscle weakness. At three weeks following admission, ultrasonography revealed C5-6 nerve root inflammatory swelling improvement. Ultrasonography may aid in the early detection of nerve root inflammatory swelling and help monitor treatment efficacy.
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Affiliation(s)
| | - Tomoo Mano
- Department of Neurology, Nara Medical University, Japan
- Department of Rehabilitation Medicine, Nara Medical University, Japan
| | - Naoki Iwasa
- Department of Neurology, Nara Medical University, Japan
| | | | - Kozue Saito
- Department of Neurology, Nara Medical University, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Japan
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Wada S, Hirano H, Uehara N, Kurotobi Y, Tsuzaki K, Takamatsu N, Fujita M, Hamano T. Cervical Root Enlargement in Segmental Zoster Paresis: A Study with Magnetic Resonance Imaging and Nerve Ultrasound. Intern Med 2022; 61:2361-2365. [PMID: 35022345 PMCID: PMC9424074 DOI: 10.2169/internalmedicine.8538-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 72-year-old woman presented with acute-progressive muscle weakness after a rash in the left upper limb. Muscle weakness was restricted to the left C5 innervated muscles. Short inversion time inversion recovery magnetic resonance imaging (MRI) showed a high-intensity signal in the left C5 nerve root, and nerve ultrasound showed its enlargement. She was diagnosed with segmental zoster paralysis (SZP) and treated with acyclovir and methylprednisolone. Her muscle strength gradually recovered, and the abnormal signal and enlargement in the left C5 nerve root improved. This is the first SZP case of confirmed improvement of abnormal findings on MRI and nerve ultrasound in association with muscle power recovery.
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Affiliation(s)
- Shinichi Wada
- Department of Neurology, Kansai Electric Power Hospital, Japan
- Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Japan
| | - Hirohisa Hirano
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
| | - Naoko Uehara
- Department of Neurology, Kansai Electric Power Hospital, Japan
- Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Japan
| | - Yuri Kurotobi
- Department of Neurology, Kansai Electric Power Hospital, Japan
| | - Koji Tsuzaki
- Department of Neurology, Kansai Electric Power Hospital, Japan
- Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Japan
| | | | - Masaaki Fujita
- Department of Clinical Immunology and Rheumatology, Kansai Electric Power Hospital, Japan
| | - Toshiaki Hamano
- Department of Neurology, Kansai Electric Power Hospital, Japan
- Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Japan
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Patel KR, Darweesh S, Lund D, Vanderkolk K. A Rare Complication of Herpes Zoster: Segmental Zoster Paresis. Cureus 2022; 14:e27261. [PMID: 36039221 PMCID: PMC9403035 DOI: 10.7759/cureus.27261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 11/09/2022] Open
Abstract
Segmental zoster paresis (SZP) is a rare complication of herpes zoster (HZ) that results in focal weakness of the extremity in the myotome that corresponds to dermatomal involvement.We present a case of an 80-year-old female with a resolving HZ rash on her left leg and buttocks that presented with left leg weakness for two weeks. The patient’s rash preceded the left leg weakness by two weeks. The exam revealed erythematous macular and crusting lesions in the left L3/L4 distribution. The left thigh was flaccid with 1/5 knee extension strength with an absent patellar reflex. Lumbar spine magnetic resonance imaging (MRI) revealed enhancement of the left L4 roots, suggestive of inflammation or neuropathy. The patient was discharged on gabapentin, amitriptyline, and a two-week prednisone taper. In this case study, we present SZP, a rare complication that occurs in approximately 3% of HZ patients. The majority of SZP cases occur on the face or upper extremity, whereas our patient had SZP of the lower extremity. This case emphasizes the importance of maintaining a comprehensive differential diagnosis and highlights that SZP should be considered in patients who present with acute weakness in an extremity.
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Yamaguchi K, Kawabe-Ishibashi C, Iida S, Saito T, Takakura T. Successful management of segmental zoster paresis on the upper arm with temporally burst spinal cord stimulation. J Anesth 2022; 36:323-326. [PMID: 35274160 DOI: 10.1007/s00540-022-03056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Abstract
Segmental zoster paresis (SZP) of the limbs is characterized by a focal, asymmetric neurogenic weakness that may occur in an extremity affected by herpes zoster (HZ). In this case report, we describe the case of a patient with SZP who presented with these problems and responded well to temporary spinal cord stimulation (SCS) and systematic rehabilitation. A 62-year-old female patient was referred for right upper limb pain, weakness, and insomnia due to pain. After completing the 14-day trial stimulation, the pain numerical rating scale of the patient in the right upper extremity decreased from 8/10 to 2/10. The Athens insomnia scale score decreased from 15/24 to 10/24. Furthermore, the grip strength of the right hands increased from 6.7 to 16.8 kg at discharge. We induced temporal SCS and rehabilitation of the right upper limb SZP and successfully reduced the pain. An in-depth understanding of the neurological complications secondary to HZ should be emphasized, with temporal SCS and rehabilitation expected to play a crucial role in the motor recovery of patients with SZP.
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Affiliation(s)
- Keisuke Yamaguchi
- Department of Anesthesiology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan.
| | - Chika Kawabe-Ishibashi
- Department of Anesthesiology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Shie Iida
- Department of Anesthesiology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Takayuki Saito
- Department of Anesthesiology, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Tomokazu Takakura
- Department of Rehabilitation Medicine, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
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Tang J, Tao J, Luo G, Zhu J, Yao M. Analysis of Risk Factors and Construction of a Prediction Model of Motor Dysfunction Caused by Limb Herpes Zoster. J Pain Res 2022; 15:367-375. [PMID: 35153514 PMCID: PMC8827162 DOI: 10.2147/jpr.s346564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/28/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jiayi Tang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing and The Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China
| | - Jiachun Tao
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing and The Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China
| | - Ge Luo
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing and The Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China
| | - Jianjun Zhu
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing and The Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China
| | - Ming Yao
- Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing and The Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China
- Correspondence: Ming Yao, Department of Anesthesiology and Pain Research Center, The First Hospital of Jiaxing and The Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Nanhu District, Jiaxing City, Zhejiang Province, People’s Republic of China, Tel +86 573 13456218632, Email
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Lu X, Cheng F, Xiao F. Herpes zoster-induced acute urinary retention, limb paresis, and constipation in two immunocompetent patients. Clin Auton Res 2022; 32:77-80. [PMID: 34984570 DOI: 10.1007/s10286-021-00846-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Affiliation(s)
- XiaoYun Lu
- Department of Dermatology of First Affiliated Hospital, and Institute of Dermatology, Anhui Medical University, Hefei, 230032, Anhui, China
- Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Science and Teaching Building, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Fang Cheng
- Department of Dermatology, Second Hospital of Huangshi, Huangshi, 435002, Hubei, China
| | - FengLi Xiao
- Department of Dermatology of First Affiliated Hospital, and Institute of Dermatology, Anhui Medical University, Hefei, 230032, Anhui, China.
- Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Science and Teaching Building, 81 Meishan Road, Hefei, 230032, Anhui, China.
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Kim HS, Jung JW, Jung YJ, Ro YS, Park SB, Lee KH. Complete recovery of herpes zoster radiculopathy based on electrodiagnostic study: A case report. World J Clin Cases 2021; 9:4303-4309. [PMID: 34141794 PMCID: PMC8173409 DOI: 10.12998/wjcc.v9.i17.4303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/03/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Herpes zoster is a painful infectious disease caused by the varicella zoster virus. Herpes zoster radiculopathy, which is a type of segmental zoster paresis, can complicate the disease and cause motor weakness. This complication should be considered when a patient with a rash complains of acute-onset motor weakness, and the diagnosis can be verified via electrodiagnostic study.
CASE SUMMARY A 64-year-old female with a history of asthma presented to the emergency department with stabbing pain, an itching sensation, and a rash on the right anterior shoulder that had begun 5 d prior. Physical examination revealed multiple erythematous grouped vesicles in the right C4-5 and T1 dermatome regions. Because herpes zoster was suspected, the patient immediately received intravenous acyclovir. On the third hospital day, she complained of motor weakness in the right upper extremity. Magnetic resonance imaging of the cervical spine revealed mild intervertebral disc herniation at C4-C5 without evidence of nerve root compression. On the 12th hospital day, electrodiagnostic study revealed right cervical radiculopathy, mainly in the C5/6 roots. Six months later, monoparesis resolved, and follow-up electrodiagnostic study was normal.
CONCLUSION This case emphasizes that clinicians should consider the possibility of post-herpetic paresis, such as herpes zoster radiculopathy, and that electrodiagnostic study is useful for diagnosis and follow-up.
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Affiliation(s)
- Hyeon Seong Kim
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
| | - Ji Won Jung
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
| | - You Jin Jung
- Department of Dermatology, Hanyang University Hospital, Seoul 04763, South Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University Hospital, Seoul 04763, South Korea
| | - Si-Bog Park
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
| | - Kyu Hoon Lee
- Department of Rehabilitation Medicine, Hanyang University Hospital, Seoul 04763, South Korea
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