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. 2018 Aug 21;18(1):121.
doi: 10.1186/s12883-018-1130-4.

A retrospective case series of segmental zoster paresis of limbs: clinical, electrophysiological and imaging characteristics

Ying Liu  1 , Bing-Yun Wu  1 , Zhen-Shen Ma  2 , Juan-Juan Xu  1 , Bing Yang  3 , Heng Li  3 , Rui-Sheng Duan  4
Affiliations

A retrospective case series of segmental zoster paresis of limbs: clinical, electrophysiological and imaging characteristics

Ying Liu et al. BMC Neurol. .

Abstract

Background: Segmental zoster paresis (SZP) of limbs, characterized by focal weakness of extremity, is recognized as a rare complication of herpes zoster (HZ). The following study analyzes the clinical characteristics and data from electromyography and MRI scans in patients with motor weakness after zoster infection.

Methods: One thousand three hundred ninety-three patients from our database (Shandong Provincial Qianfoshan Hospital) suffering from HZ were retrospectively reviewed from June 2015 to July 2017. Patients who fulfilled the diagnostic criteria for SZP were included in the analysis. The clinical characteristics, as well as electromyography findings and MRI scans were analyzed.

Results: SZP was present in 0.57% of patients with HZ (8/1393). The average age of symptom onset in 8 SZP patients was 69 years old (SD: 13, range 47-87). The severity of muscle weakness ranged from mild to severe. The electrophysiological testing revealed the characteristics of axonopathy. Radiculopathy (2/8), plexopathy (2/8), radiculoplexopathy (3/8) and combined radiculopathy and mononeuropathy (1/8) were also identified. MRI revealed hyperintensity of the affected spinal dorsal horns, nerve roots or peripheral nerves.

Conclusions: SZP is associated with obvious limb weakness, nerve axons lesions and localization to nerve roots, plexus or peripheral nerves.

Keywords: Electromyography; Herpes zoster; Infectious neuropathy; Nerve MRI; Nerve conduction; Segmental zoster paresis.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the ethic committee of the Shandong Provincial Qianfoshan Hospital, Shandong University. Six patients signed the informed consents and two patients were not contacted before the submission. Exception to the requirement of informed consent was obtained from the ethic committee due to the retrospective study.

Consent for publication

Written informed consent was obtained from the patients described in cases (case 1, 2, 3, 5, 7and 8) for the publication of their personal and medical information and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Rash distribution in all patents corresponds to weakness distribution. Scars of a prior herpetic eruption and pigmentation over the dorsum and planta of the right foot were seen in patient 3, who had a foot drop (a and b). Scars from prior herpetic eruption and pigmentation over the right shoulder and anterolateral arm were seen in patient 8, who could not elevate her shoulder (c and d)
Fig. 2
Fig. 2
Eight patients had a different prognosis. Patient 1 recovered completely 3 months after symptoms onset. Patient 6 and 8 recovered partially through 1 or 0.5 year respectively. However, the remaining five patients did not recover until 0.5–2.0 years of follow-up
Fig. 3
Fig. 3
Distal motor latency and nerve conduction velocity of affected nerves. The distal motor latencies were all shorter than 130% of the upper limit of normal. The nerve conduction velocities were all above 35 m/s. M: motor nerve; S: sensory nerve
Fig. 4
Fig. 4
Imaging characteristics of patients with SZP. Axial T2-weighted image showed the unilateral hyperintensity in the dorsal horn of C5 spinal cord in patient 2 (a). Brachial plexus magnetic resonance imaging showed hyperintensity of C6–8 nerve roots in patient 5 (b), left median and radial nerves in patient 7 (c) and C5 nerve roots in patient 8 (d)
See this image and copyright information in PMC

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