Clinical note
Segmental Zoster Paresis of the Upper Extremity: A Case Report

Presented as a poster to the 2nd World Congress of the International Society of Physical and Rehabilitation Medicine, May 18–22, 2003, Prague, Czech Republic.
https://doi.org/10.1016/j.apmr.2004.09.032Get rights and content

Abstract

Yoleri Ö, Ölmez N, Öztura İ, Şengül İ, Günaydın R, Memiş A. Segmental zoster paresis of the upper extremity: a case report.

Segmental zoster paresis, a rare complication of herpes zoster, is characterized by focal, asymmetric motor weakness in the myotome that corresponds to the dermatome of the rash. The pathogenesis of segmental zoster paresis is inflammation caused by the spread of the herpes virus. Motor damage may affect the root, plexus, or peripheral nerve. A woman in her early seventies with right shoulder pain and shoulder girdle muscle weakness was diagnosed with involvement of the C5–7 motor roots and upper truncus of the brachial plexus as a complication of herpes zoster. Recognition of herpes zoster as a cause of acute motor weakness is important in avoiding unnecessary interventions as well as in determining the treatment and outcome of the patient. This case is presented to emphasize that herpes zoster infection may be complicated by segmental paresis, which should be considered in the differential diagnosis of acute painful motor weakness of the upper extremity.

Section snippets

Case description

A woman in her early seventies was referred for right shoulder pain and weakness to the Physical Medicine and Rehabilitation Department of Izmir Atatürk Training Hospital. Six weeks previously, she had complained of pain in her right shoulder followed by a vesicular eruption on the same area. A diagnosis of herpes zoster was made by the dermatologist she saw, but antiviral therapy was not administered. About 2 weeks later, she became unable to elevate her right arm to shoulder level. There was

Discussion

Segmental zoster paresis represents a slow extension of viral inflammation from the sensory ganglion to the spinal cord, roots, plexus, and peripheral nerve, as shown in an electrophysiologic study done by Cockerell and Ormerod.10 This is reflected in the wide spectrum of clinical presentations with which zoster paresis challenges the physician trying to make a diagnosis.

Radiculopathy is a common form of herpes zoster-related motor weakness, described in several reports in the literature. Focal

Conclusions

Segmental paresis is a rare complication of herpes zoster. The exact pathogenesis is uncertain. An inflammatory response triggered by viral spread is the usual cause. The facial nerve is commonly involved, followed by the upper extremities. Clinical symptomatology may vary greatly. The sensory ganglion, spinal cord, the roots, plexus, and the peripheral nerves may be affected. Diagnosis depends on medical history and clinical findings, but electromyography and radiologic investigations are

References (16)

  • M. Mondelli et al.

    Herpes zoster of the head and limbselectroneuromyographic and clinical findings in 158 consecutive cases

    Arch Phys Med Rehabil

    (2002)
  • D.L. Braverman et al.

    Herpes zoster polyradiculopathy

    Arch Phys Med Rehabil

    (1997)
  • M.P. Merchut et al.

    Segmental zoster paresis of limbs

    Electromyogr Clin Neurophysiol

    (1996)
  • P.G. Kennedy et al.

    Studies on the pathogenesis of neurological diseases associated with varicella-zoster virus

    Neuropathol Appl Neurobiol

    (1990)
  • S.K. Gupta et al.

    The prognosis in zoster paralysis

    J Bone Joint Surg Br

    (1969)
  • J.E. Thomas et al.

    Segmental zoster paresisa disease profile

    Neurology

    (1972)
  • C.F. Burgoon et al.

    The natural history of herpes zoster

    JAMA

    (1957)
  • M.K. Greenberg et al.

    Segmental motor involvement in herpes zosteran EMG study

    Neurology

    (1992)
There are more references available in the full text version of this article.

Cited by (41)

  • Diagnostic Methods and Management Strategies of Herpes Simplex and Herpes Zoster Infections

    2024, Clinics in Geriatric Medicine

  • Herpes zoster brachial plexopathy. A case report

    2017, Rehabilitacion

  • Herpes zoster motor neuropathy

    2016, FMC Formacion Medica Continuada en Atencion Primaria

  • Diagnostic methods and management strategies of herpes simplex and herpes zoster infections

    2013, Clinics in Geriatric Medicine

  • An unusual cause of dyspnea in a patient with cervical herpes zoster

    2012, Journal of Clinical Neuroscience
    Citation Excerpt :

    The patient’s pain resolved three months later, and the patient underwent outpatient follow-up for two years without further complications. Cervical zoster paresis can affect any muscle, including shoulder, arm, and respiratory muscles; however, it had been least frequently reported in respiratory muscles.4,5 Paradoxical abdominal wall movement has been considered a characteristic clinical sign of respiratory muscle involvement, particularly of the diaphragm.6

  • Neurologic Manifestations of Herpes Zoster

    2011, Neuroinflammation
View all citing articles on Scopus

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.

View full text
Copyright © 2005 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.