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Journal of Medical Case Reports

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Open Access 01-12-2021 | Shingles | Case report

Zoster-associated limb paralysis mimicking acute stroke: a case report

Authors: Chamara Dalugama, Ruwanthi Jayasinghe, Nimanthi Rathnayaka, Arjuna Medagama

Published in: Journal of Medical Case Reports | Issue 1/2021

Abstract

Background

Varicella zoster virus is a Deoxyribonucleic acid (DNA) virus exclusively affecting humans. Reactivation of varicella zoster virus causes herpes zoster with vesicular eruptions in a restricted dermatomal distribution. Peripheral motor neuropathy is a very rare complication of varicella zoster virus.

Case presentation

A 57-year-old previously well Sri Lankan female presented with acute onset painful weakness of the left upper limb with a preceding history of a febrile illness. Subsequently she developed vesicular eruptions in the dermatomal distribution of cervical 5, 6, and 7. Electromyography was suggestive of acute denervation of cervical 5, 6, and 7 myotomes. Diagnosis of zoster-associated brachial plexopathy was made, and the patient was treated with acyclovir, steroids, and analgesics. She made a good recovery.

Conclusion

Brachial plexus neuritis due to varicella zoster infection should be considered in an acute monoparesis of a limb as it is a treatable and reversible condition

Wittek M, Doerr HW, Allwinn R. Varicella and herpes zoster. Part 1: virology, epidemiology, clinical picture, laboratory diagnostics. Med Klin Munich. 2010;105(5):334–8. https://doi.org/10.1007/s00063-010-1061-3.CrossRefPubMed

Schmader K, Gnann JW Jr, Watson CP. The epidemiological, clinical, and pathological rationale for the herpes zoster vaccine. J Infect Dis. 2008;197(Suppl 2):S207–15. https://doi.org/10.1086/522152.CrossRefPubMed

Breuer J, Whitley R. Varicella zoster virus: natural history and current therapies of varicella and herpes zoster. Herpes. 2007;14(Suppl 2):25–9.PubMed

Halpern SL, Covner AH. Motor manifestations of Herpes zoster: report of a case of associated permanent paralysis of the phrenic nerve. Arch Intern Med (Chic). 1949;84(6):907–16. https://doi.org/10.1001/archinte.1949.00230060064005.CrossRef

Devaraj NK. Antibiotic resistance: a real menace. Oman Med J. 2017;32(6):531.CrossRef

Devaraj NK, Suppiah S, Veettil SK, Ching SM, Lee KW, Menon RK, Soo MJ, Deuraseh I, Hoo FK, Sivaratnam D. The effects of probiotic supplementation on the incidence of diarrhea in cancer patients receiving radiation therapy: a systematic review with meta-analysis and trial sequential analysis of randomized controlled trials. Nutrients. 2019;11(12):2886.CrossRef

Lyngeberg KK, Swensson BH. Herpes zoster paresis. A review of the literature and case reports. Ugeski Laeger. 1990;152:1214–7.

Zubair AS, Hunt C, Watson J, Nelson A, Jones LK Jr. Imaging findings in patients with zoster-associated plexopathy. AJNR Am J Neuroradiol. 2017;38:1248–51.CrossRef

Choi JY, Kang CH, Kim BJ, et al. Brachial plexopathy following herpes zoster infection: two cases with MRI findings. J Neurol Sci. 2009;285:224–6.CrossRef

10.

Ayoub T, Raman V, Chowdhury M. Brachial neuritis caused by varicella-zoster diagnosed by changes in brachial plexus on MRI. J Neurol. 2010;257:1. https://doi.org/10.1007/s00415-009-5266-4.CrossRefPubMed

11.

Mullins GM, O’Sullivan SS, Neligan A, et al. Non-traumatic brachial plexopathies, clinical, radiological and neurophysiological findings from a tertiary centre. Clin Neurol Neurosurg. 2007;109:661–6.CrossRef

12.

Fabian VA, Wood B, Crowley P, et al. Herpes zoster brachial plexus neuritis. Clin Neuropathol. 1997;16:61–4.PubMed

13.

Jeevarethinam A, Ihuoma A, Ahmad N. Herpes zoster brachial plexopathy with predominant radial nerve palsy. Clin Med. 2009;9:500–1.CrossRef

14.

Ohtake T, Komori T, Hirose K, Tanabe H. Monoparesis due to the brachial plexus neuritis by herpes zoster virus—report of a case. Rinsho Shinkeigaku. 1991;31:1245–7.PubMed

15.

Ismail A, Rao DG, Sharrack B. Pure motor herpes zoster induced brachial plexopathy. J Neurol. 2009;256:1343–5.CrossRef

16.

Hoque R, Schwendimann RN, Liendo C, Chesson AL Jr. Brachial neuritis with bilateral diaphragmatic paralysis following herpes zoster: a case report. J Clin Neuromuscul Dis. 2008;9:402–6.CrossRef

17.

Elliott KJ. Other neurological complications of herpes zoster and their management. Ann Neurol. 1994;35(Suppl):S57.CrossRef

18.

Merchut MP, Gruener G. Segmental zoster paresis of limbs. Electromyogr Clin Neurophysiol. 1996;36:369.PubMed

19.

Kawajiri S, Tani M, Noda K, Fujishima K, Hattori N, Okuma Y. Segmental zoster paresis of limbs: report of three cases and review of literature. Neurologist. 2007;13:313–7.CrossRef

20.

Han Y, Zhang J, Chen N, He L, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2013;3:CD005582.

21.

He L, Zhang D, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2008;1:CD005582.

22.

Mondelli M, Romano C, Passero S, Porta PD, Rossi A. Effects of acyclovir on sensory axonal neuropathy, segmental motor paresis and post-therapeutic neuralgia in herpes zoster patients. Eur Neurol. 1996;36:288–92.CrossRef

23.

Whitley RJ, Weiss H, Gnann JW Jr, Tyring S, Mertz GJ, Pappas PG, Schleupner CJ, Hayden F, Wolf J, Soong SJ. Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med. 1996;125:376–83.CrossRef

24.

Araz C, Askin S, Cem Y. Herpes zoster brachial plexopathy: direct steroid injection. Turk Neurosurg. 2017;27(4):662–4. https://doi.org/10.5137/1019-5149.JTN.13589-14.1.CrossRefPubMed

25.

Kim JY, Song SH, Kim SH, Koh KH, Yoo JH. A fast recovery of muscle weakness after zoster-induced brachial plexitis. J Korean Orthop Assoc. 2017;52(4):350–3. https://doi.org/10.4055/jkoa.2017.52.4.350.CrossRef

26.

Lim SM, Park HL, Moon HY, Kang KH, Baek CH, Jung YH, Kim JY, Koo GH, Shin HY. Ultrasound-guided infraorbital nerve pulsed radiofrequency treatment for intractable postherpetic neuralgia—a case report. Korean J Pain. 2013;26:84–8.CrossRef

27.

Sáenz-Farret M, Sandoval-Rodríguez V, Paz-Navarro CE, Zúñiga-Ramírez C. Successful treatment of brachial plexopathy due to herpes zoster infection with intravenous immunoglobulin. Clin Neuropharmacol. 2017;40(1):43–7.CrossRef

Title: Zoster-associated limb paralysis mimicking acute stroke: a case report
Authors: Chamara Dalugama
Ruwanthi Jayasinghe
Nimanthi Rathnayaka
Arjuna Medagama
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Shingles
Neurotomy
Stroke
Human Alphaherpesvirus 3
Published in: Journal of Medical Case Reports / Issue 1/2021
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-021-02971-7

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Zoster-associated limb paralysis mimicking acute stroke: a case report

Abstract

Background

Case presentation

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Case presentation

Conclusion

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