Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net Letter
2006:72:3;252-252
doi: 10.4103/0378-6323.25800
PMID: 16766851

Segmental motor paralysis of the right upper limb in herpes zoster

Karjigi Siddalingappa, K Lokanatha
 Department of Skin and STD, VIMS, Bellary, India

Correspondence Address:
Karjigi Siddalingappa
Department of Skin and STD, VIMS, Bellary, Karnataka 583 104
India
How to cite this article:
Siddalingappa K, Lokanatha K. Segmental motor paralysis of the right upper limb in herpes zoster. Indian J Dermatol Venereol Leprol 2006;72:252
Copyright: (C)2006 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Herpes zoster is due to reactivation of varicella-zoster virus lying dormant in the dorsal root ganglion. It is characterized by pain or burning sensation in the involved dermatome with a grouped vesicular rash. In herpes zoster, acute inflammatory changes occur in the posterior nerve root and ganglia. Among the complications of herpes zoster, involvement of motor neurons is rare and may lead to paresis or complete paralysis of the muscles supplied by the affected segments. We are reporting a case of unilateral right C4, C5 and C6 segmental motor paralysis attributable to herpes zoster in an otherwise healthy individual for its rarity.

A 70-year-old man had severe pain and multiple grouped vesiculobullous eruption over erythematous background along C 4, 5, 6 dermatomes since 5 days. Seven days after the onset of rash, he noticed inability to move his right upper limb. The patient was not a known diabetic or hypertensive. On examination of the right upper limb, there were absolutely no movements of the right shoulder joint. In the right elbow joint, the power of the muscles supplied by C 4, 5, 6 segments was grade zero. Other systemic examination was normal.

Routine hematologic, biochemical, urine and stool examinations were within normal limits. Blood VDRL, HIV were negative. Radiographs of the cervical spine (anteroposterior, lateral and oblique views) were normal. We could not perform electromyogram and nerve conduction studies due to lack of facilities. The patient was treated with oral acyclovir 800 mg, five times per day, for 10 days for herpes zoster along with symptomatic care. The skin lesions healed slowly in about 3 weeks. Patient was seen by a physician and was advised physiotherapy. However, muscle power recovered gradually at the end of 5 months. He was able to flex and extend his elbow, with recovery of shoulder movements.

Broadbent first described herpes zoster related paralysis in 1866. About 5-30% patients[1] with typical cutaneous lesions develop some form of motor weakness affecting the myotomal muscles corresponding to the dermatomal distribution of skin lesions. The weakness usually develops within 2 to 3 weeks after the onset of the skin eruption. Its onset is abrupt, occurring over hours or 1 to 2 days, with little or no subsequent deterioration. Zoster paresis occurs more often in the upper than in the lower extremity, preferentially segments C5 and C6.[1] Segmental motor paralysis of the limbs (SMP) complicates 2-3% of the cases of cutaneous herpes zoster. Viral invasion and inflammation of the motor neurons of the anterior horn cells by the Varicella-zoster virus (VZV) causes clinical weakness at the same time and site as the cutaneous eruption. VZV should be considered amongst the etiologies of SMP, even in the absence of cutaneous lesions (zoster sine herpete).[2] During reactivation of virus, direct invasion of adjacent structures may occur. This may lead to involvement of the anterior horn neurons, resulting in muscular weakness, cranial nerve palsies, diaphragmatic paralysis, neurogenic bladder and colon pseudo-obstruction. Rarely, VZV infection may result in myotomal motor weakness or paralysis in addition to a painful dermatomal rash.[3] But limb muscles paralysis is rare.[4]

The cause for motor paresis is unclear. It is postulated that the virus spreads proximally as well as distally, causes a local neuritis in the spinal nerve and subsequently gains access to the motor axons. Evidence for viral migration into the central nervous system has been found in the cerebrospinal fluid of patients with isolated cutaneous zoster.

Herpes zoster affects 10-20% of the general population.[5] While the majority of complications manifest as sensory disturbances, 5% are motor neuropathies, with half involving the cranial nerves.[5] The motor system may be affected in the form of paresis or paralysis of the muscles. A patient with herpes zoster of the C4, C5 and C6 dermatomes developed left upper arm monoplegia. Brachial plexus neuritis may be a direct cause of reversible upper limb paresis in herpes zoster.[6] Our patient had complete paralysis of the muscles supplied by the C4, C5 and C6 segments. The cause of muscle paresis in herpes zoster is unclear. It may probably be due to myositis or ganglio-muscular disease following infection of proprioceptive ganglion cells.[7]

References
1.
Braverman DL, Ku A, Nagler W. Herpes Zoster polyradiculopathy. Arch Phys Med Rehabil 1997;78:880-2.
[Google Scholar]
2.
Cruz-Velarde JA, Munoz-Blanco JL, Traba A, Nevado C, Ezpeleta D. Segmental motor paralysis caused by the Varicella-Zoster virus. Clinical study and functional prognosis. Rev Neurol 2001;32:15-8.
[Google Scholar]
3.
Yaszay B, Jablecki CK, Safran MR. Zoster paresis of the shoulder. Clin Orth Relat Res 2000;377:112-8.
[Google Scholar]
4.
Haribhakti PB, Macwan R. Viral skin infections, In : Valia RG, Valia AR editors. IADVL Text book and atlas of Dermatology. 2nd ed. Bhalani Publishing House: Mumbai; 2001. p. 295-301.
[Google Scholar]
5.
Vincent KD, Davis LS. Unilateral abdominal distension following herpes zoster outbreak. Arch dermatol 1998;134;1168-9.
[Google Scholar]
6.
Fabian VA, Wood B, Crowley P, Kakulas BA. Herpes zoster brachial plexus neuritis. Clin Neuropathol 1997;16:61-4.
[Google Scholar]
7.
Noris FH, Dramov B, Calder CD, Johnson SG. Virus-like particles in myositis accompanying herpes zoster. Arch Neurol 1969;21:25-31.
[Google Scholar]

Fulltext Views
1,398

PDF downloads
1,744
Show Sections