Shingles Radiculoplexoneuropathy

Adebisi Idowu Obafemi^1, and Nicole Terese Golden¹

¹Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas

Cite this paper

Adebisi Idowu Obafemi and Nicole Terese Golden. Shingles Radiculoplexoneuropathy. American Journal of Medical Case Reports. 2018; 6(10):210-213. doi: 10.12691/AJMCR-6-10-4

Abstract

We report on a 59 year old man with background history of hypertension who presented to our clinic with vesicular rash of two days duration extending from the right deltoid region to the dorsum of the fingers. He was treated with Valacyclovir plus oral steroid and Tramadol after a clinical diagnosis of shingles; he represented one week later with worsening pain. At that time the vesicular rash were crusting and dry. He was diagnosed with post herpetic neuralgia and his pain medication dosage was adjusted. He represented again two weeks after the initial appearance of rash with complaints of weakness in the right upper extremity. Physical examination confirmed the weakness in the proximal and distal muscle groups of the right arm associated with weak hand and finger grips. He was then referred for electromyography and nerve conduction studies. The result showed the right ulnar motor response recording at abductor digit minimi (ADM) and first dorsal interosseous (FDI) had prolonged latency, reduced amplitude and slowed conduction velocity. The findings are most consistent with right radiculoplexoneuropathy affecting predominantly lower plexus. (EMG/NCS table). He was referred for physical therapy and regained full functions of the right upper extremity after 6 weeks of therapy. Segmental motor weakness secondary to Varicella Zoster infection is uncommon; as a result, clinicians may not suspect it and it may be confused with Parsonage-Turner syndrome, brachial plexus syndrome, cervical radiculopathy and myelopathy particularly if the rash is not obvious or absent leading to delayed diagnosis and or investigations.

Keywords

shingles, brachial plexopathy, motor weakness, varicella zoster

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Manian FA, Kindred M, Fulling KH: Chronic varicella-zoster virus myelitis without cutaneous eruption in a patient with AIDS: report of a fatal case. Clin Infect Dis. 1995: 21 (4): 986.
[2]	Chretien F, Gray F, Lescs MC: Acute varicella-zoster virus ventriculitis and meningo-myelo-radiculitis in acquired immunodeficiency syndrome. Acta Neuropathol 1993; 86: 659.
[3]	Dworkin RH, Johnson RW, Breuer J, Gnann JW, LevinMJ, Backonja M.et al: Recommendations for the management of herpes zoster. Clin Infvect Dis. 2007; 44 Suppl 1:S1.
[4]	Gilden, D, Nagel Maria, Ransohoff, RM, Cohrs Randall, Mahalingam, R Tanabe J: Recurrent varicella zoster virus myelopathy. J Neurol Sci, 2009 Jan 15.
[5]	Choi JY, Kang CH, Kim BJ, Park KW, Yu SW: Brachial Plexopathy following herpes Zoster infection: two cases with MRI findings.
[6]	Gilden DH. Beinleich BR. Rubinstein EM, Stommel R, Swenson R, Rubinstein D Mahalingam R. Varicella-zoster virus myelitis: an expanding spectrum . Neurology: 1994; 44: 1818-23.
[7]	De Silva SM, Mark AS, Gilden DH, Mahalingam R, Balish M, Sandbrind F, Houff S. Zoster myelitis improvement with antiviral therapy in two cases. Neurology. 1996; 47: 929-31.
[8]	Haanpaa, M, Hakkinen V, Nurmikko: Motor involvement in acute herpes zoster. Muscel Nerve, 20 (1997).
[9]	Gupta SK, Helas BH, Kiely P: The prognosis in zoster paralysis. J Bone Joint Surg Br, 51 (1969), pp. 593-603.
[10]	Thomas JE, Howard Jr: Segmental zoster paresis- a disease profile. Neurology; 22 (1972), pp. 459-466.
[11]	Rowbotham M, Harden N, Stacey B, et al. Gabapentin for the treatment of post herpetic neuralgia; a randomized controlled trial. JAMA 1998; 280-1837.
[12]	Elliot KJ. Other Neurological complications of herpes zoster and their management. Ann Neurol 1994; 35 Supple. S57.
[13]	Gold E. Serologic and virus-isolation studies of patients with varicella or herpes-zoster infection. N Engl J Med 1966; 274: 181.
[14]	Chang CM, Woo E, Yu YL, et al. Herpes zoster and its neurological complications. Postgrad Med J1987, 63: 85.
[15]	Albrecht, MA, Hirsch MS, Mitty J: Clinical Manifestations of varicella-zoster virus infection: UpToDate. Https://www.uptodate.com/contents/clinical-manifestations-of-varicella-zoster.
[16]	Gopal KVT, Sarvani D, Krishnam Raju PV, Raghurama Rao, Venkateswarlu K: Herpes zoster motor neuropathy: A clinical and electrophysiological study. Indian Journal of Dermatology, Venereology, and Leprology. 2010; V.76. Pg. 569-571.