Gül Sedat, Ahmed Adeenah F, McGraw Corey, Nasany Ruham Alshiekh
Neurology, State University of New York Upstate Medical University, Syracuse, USA.
Cureus. 2023 Jun 2;15(6):e39876. doi: 10.7759/cureus.39876. eCollection 2023 Jun.
Varicella zoster virus (VZV)-associated plexopathy mainly occurs in patients over 60 years old. Postherpetic neuralgia is a well-known complication of herpes zoster (HZ); however, segmental zoster paresis secondary to HZ was reported in 1-20% of cases in the literature. Magnetic resonance imaging (MRI) findings may be positive in up to 70% of the patients. We describe a 43-year-old male patient with a history of grade two left frontal oligodendroglioma, which was treated with two partial resections, radiation treatment and procarbazine/lomustine, who presented with left upper extremity pain and developed a blistering rash in a dermatomal pattern in the left proximal upper extremity two weeks after the initial symptoms. He was diagnosed with shingles and treated with steroids and acyclovir with minimal improvement. Six weeks after the initial symptoms, a physical exam revealed left deltoid, supraspinatus and infraspinatus weakness with normal muscle stretch reflexes and decreased sensation on the C5 dermatome. Electromyography (EMG) revealed absent left lateral antebrachial cutaneous sensory nerve action potentials (SNAP) amplitude and a small left radial SNAP amplitude compared to the right side. Evidence of ongoing denervation with reinnervation was seen in the left upper trunk-supplied muscles. MRI of the brachial plexus was negative for any abnormalities. The patient was diagnosed with VZV-associated plexopathy, which improved with pregabalin and physical therapy. Our patient was significantly younger than expected in the HZ group. MRI usually shows T2 hyperintensities and thickening of the nerve roots in patients with VZV-associated plexopathy. However, the presentation, onset of symptoms, characteristics of the rash, and clinical course were diagnostic of HZ, and the weakness pattern, supported by the EMG findings, was diagnostic of VZV-associated plexopathy.
水痘带状疱疹病毒（VZV）相关性臂丛神经病主要发生于60岁以上患者。带状疱疹后神经痛是带状疱疹（HZ）的一种常见并发症；然而，文献报道HZ继发的节段性带状疱疹性轻瘫病例占1%-20%。磁共振成像（MRI）检查结果在高达70%的患者中可能呈阳性。我们描述了一名43岁男性患者，有二级左额叶少突胶质细胞瘤病史，曾接受两次部分切除术、放射治疗及丙卡巴肼/洛莫司汀治疗，该患者最初出现左上肢疼痛，初始症状出现两周后，左上肢近端出现沿皮节分布的水疱样皮疹。他被诊断为带状疱疹，接受了类固醇和阿昔洛韦治疗，但改善甚微。初始症状出现六周后，体格检查发现左三角肌、冈上肌和冈下肌无力，肌肉牵张反射正常，C5皮节感觉减退。肌电图（EMG）显示左侧前臂外侧皮神经感觉神经动作电位（SNAP）波幅消失，左侧桡神经SNAP波幅较右侧小。在左上肢干支配的肌肉中可见到失神经再支配的证据。臂丛神经MRI检查未发现任何异常。该患者被诊断为VZV相关性臂丛神经病，经普瑞巴林和物理治疗后病情好转。我们的患者比HZ组预期的年龄要小得多。VZV相关性臂丛神经病患者的MRI通常显示T2高信号和神经根增粗。然而，该患者的表现、症状发作、皮疹特征及临床病程符合HZ诊断，而EMG结果支持的无力模式则符合VZV相关性臂丛神经病的诊断。
