Korean J Clin Neurophysiol.  2015 Dec;17(2):86-90. 10.14253/kjcn.2015.17.2.86.

Subacute Brachial Radiculoplexitis Following Herpes Zoster Infection

• Kim JH
• Kim YD
• Na SJ
• Lee KO
• Yoon B

• KMID: 2403246
• DOI: http://doi.org/10.14253/kjcn.2015.17.2.86

Abstract

Brachial radiculoplexitis is characterized by acute onset of shoulder and arm pain followed by weakness and sensory loss. Brachial radiculoplexitis by herpes zoster is a rare disease, which can be diagnosed by careful history, electrodiagnosis and MRI. It has remained uncertain about clinical characteristics, treatment, and prognosis. Better understanding of this disease helps earlier diagnosis and prompt treatment to minimize neurologic sequale. We present two cases of subacute brachial radiculoplexitis preceded by herpes zoster infection.

Keyword

Brachial plexopathy; Brachial radiculoplexitis; Herpes zoster

MeSH Terms

Arm
Brachial Plexus Neuropathies
Diagnosis
Electrodiagnosis
Herpes Zoster*
Magnetic Resonance Imaging
Prognosis
Rare Diseases
Shoulder

Figure

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  Fig. 1. Skin lesions of case 1. The patient had multiple erythematous crusted plaques on the right arm (C5-6 dermatome areas).

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  Fig. 2. Brachial plexus magnetic resonance imaging (MRI) of case 1 and 2. They were performed at 10 days after the onset of motor weakness. In case 1 (A-D), abnormal diffuse enhancement and thickening involving right brachial plexus, especially C5-6 root are shown on T2 short tau inversion recovery (STIR) coronal image (A), and modified Dixon contrast enhanced image (B). Moreover, abnormal enhancement of right upper trunk is shown on T2 STIR coronal (C) and 3 mm reconstruction coronal image (D). In case 2 (E-H), T2 STIR coronal (E) and 3 mm reconstruction coronal image (F) demonstrate abnormal diffuse enhancement and thickening involving left brachial plexus, especially C5-7 root. In addition, T2 STIR coronal (G) and 5 mm reconstruction coronal image (H) show enhancement and thickening of left upper and middle trunk.

Reference

1.Weaver BA. Herpes zoster overview: natural history and incidence. J Am Osteopath Assoc. 2009. 109:2–6.

2.Merchut MP., Gruener G. Segmental zoster paresis of limbs. Electromyogr Clin Neurophysiol. 1996. 36:369–375.

3.Haanpaa M., Hakkinen V., Nurmikko T. Motor involvement in acute herpes zoster. Muscle Nerve. 1997. 20:1443–1448.

4.Tsairis P., Dyck PJ., Mulder DW. Natural history of brachial plexus neuropathy. Report on 99 patients. Arch Neurol. 1972. 27:109–117.

5.Beqhi E., Kurland LT., Mulder DW., Nicolosi A. Brachial plexus neuropathy in the population of Rochester, Minnesota. Ann Nuurol. 1985. 18:320–323.

6.Ayoub T., Raman V., Chowdhury M. Brachial neuritis caused by varicella-zoster diagnosed by changes in brachial plexus on MRI. J Neurol. 2010. 257:1–4.

7.Jones LK Jr., Reda H., Watson JC. Clinical, electrophysiologic, and imaging features of zoster-associated limb paresis. Muscle Nerve. 2014. 50:177–185.

8.Eyigor S., Durmaz B., Karapolat H. Monoparesis with complex regional pain syndrome-like symptoms due to brachial plexopathy caused by the varicella zoster virus: a case report. Arch Phys Med Rehabil. 2006. 87:1653–1655.