Occurrence of Segmental Zoster Paresis in the Right Arm of an Adult with Multiple Sclerosis: A Case Report
Resource
Taiwan Journal of Physical Medicine and Rehabilitation,37(1),39-43.
Journal
中華心理學刊
Pages
39-43
Date Issued
2009-01
Date
2009-01
Author(s)
Lin, S.H.
Chen, W.S.
Abstract
Segmental zoster paresis is a rare complication of cutaneous herpes zoster. Clinical diagnosis of segmental zoster paresis depends upon a history of painful vesicular eruptions in a dermatomal distribution, followed by muscle weakness in the related myotomes. We report the case of a 45-year-old woman with opticospinal type multiple sclerosis with recent cutaneous herpes zoster and right shoulder girdle weakness. Differential diagnosis included multiple sclerosis relapse, zoster myelitis, segmental zoster shoulder paresis, cervical radiculopathy, and shoulder joint or soft-tissue disorders. MRI with gadolinium enhancement of the spinal cord 1 week after the onset of symptoms showed neither new multiple sclerosis plaque nor abnormal contrast-enhanced lesion. Right shoulder soft-tissue sonography revealed normal joint and soft tissue. Needle electromyography 3 weeks after the onset of weakness indicated increased spontaneous activity at the right biceps, anterior deltoid, and C4-C7 paraspinal muscles, as well as increased polyphasic waves at the right biceps muscle. These findings were compatible with recent right cervical polyradiculopathies involving at least the C4 to C7 levels. Therefore, the most likely etiology for her right shoulder girdle weakness was segmental zoster paresis. The patient received early antiviral therapy and intensive rehabilitation. Two months later, her shoulder muscle strength improved although it hadn't recovered to her premorbid status. The functional recovery in her right upper limb was good. Segmental zoster paresis is underdiagnosed in patients with segmental weakness. Needle electromyography is a good tool for assisting diagnosis and prognosis and for following up motor recovery. With early diagnosis, antiviral therapy and rehabilitation therapy can hasten neurological and functional recovery.
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