acyclovir and Brachial-Plexus-Neuropathies

Varicella zoster reactivation ("shingles" or "herpes zoster") usually presents as a self-limiting, unilateral, dermatomal vesicular rash in older adults. We present the case of a 73 year-old woman with unilateral brachial plexopathy, an unusual but debilitating complication of shingles. Despite treatment with intravenous acyclovir and immunoglobulin she had a marked residual motor paresis that required an upper limb rehabilitation program after discharge.

Topics: Acyclovir; Aged; Brachial Plexus Neuropathies; Female; Herpes Zoster; Herpesvirus 3, Human; Humans

We report a preterm neonate born with respiratory distress. The neonate was found to have diaphragmatic palsy and brachial palsy. The neonate was born by caesarean section and there was no history of birth trauma. On examination, there was bilateral congenital talipes equinovarus and a scar was present on the forearm. The mother had a history of chickenpox during the 16 weeks of pregnancy for which no treatment was sought. On investigation, PCR for varicella was found to be positive in the neonate.

Topics: Acyclovir; Anti-Bacterial Agents; Brachial Plexus Neuropathies; Casts, Surgical; Cesarean Section; Chickenpox; Clubfoot; Female; Fetal Diseases; Forearm; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Mothers; Pregnancy; Pregnancy Complications, Infectious; Respiratory Paralysis; Treatment Outcome

The etiologies of Bell's palsy and brachial neuritis remain uncertain, and the conditions rarely co-occur or reoccur. Here we present a woman in her twenties who had several relapsing-remitting episodes with left-sided facial palsy and brachial neuropathy. The episodes always started with painful left-sided oral blisters. Repeat PCRs HSV-1 DNA from oral vesicular lesions were positive. Extensive screening did not reveal any other underlying cause. Findings on MRI T2-weighted brachial plexus STIR images, using a 3.0-Tesla scanner during an episode, were compatible with brachial plexus neuritis. Except a mannose-binding lectin deficiency, a congenital complement deficiency that is frequently found in the general Caucasian population, no other immunodeficiency was demonstrated in our patient. In vitro resistance to acyclovir was tested negative, but despite prophylactic treatment with the drug in high doses, relapses recurred. To our knowledge, this is the first ever reported documentation of relapsing-remitting facial and brachial plexus neuritis caused by HSV-1.

Topics: Acyclovir; Antiviral Agents; Brachial Plexus; Brachial Plexus Neuropathies; Chemoprevention; DNA, Viral; Facial Paralysis; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Mannose-Binding Lectin; Mouth Mucosa; Recurrence; Young Adult

Brachial plexus neuritis in the presence of herpes zoster infection is uncommon. Motor involvement is probably due to the spreading of inflammation from the dorsal root ganglia to the ventral roots and may be more extensive than the affected dermatomes. We present a case of herpes zoster brachial plexopathy with pure motor involvement both clinically and electrophysiologically.

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Arm; Axons; Brachial Plexus Neuropathies; Electrodiagnosis; Electromyography; Exanthema; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Motor Neuron Disease; Motor Neurons; Muscle Weakness; Muscle, Skeletal; Muscular Atrophy; Neural Conduction; Spinal Nerve Roots; Treatment Failure; Wallerian Degeneration

Viral invasion of the motoneurons and the subsequent inflammation in the anterior horn cells by the varicella zoster virus results in a weakness in the area of the cutaneous eruption. The exact mechanism of zoster paresis is uncertain. The occurrence of symptoms resembling complex regional pain syndrome (CRPS) is common in subjects where the herpes zoster (HZ) outbreak affects an extremity, particularly if it is the distal extremity that is involved. We report the case of a 54-year-old man with monoparesis, hyperalgesia, allodynia, edema, and both color and skin-temperature changes in his left arm after a skin eruption. Electrophysiologic examination revealed the partial degeneration of the superior, middle, and inferior truncus in the brachial plexus, with evidence of HZ infection. Magnetic resonance imaging of the cervical spine and brachial plexus showed degenerative changes without any evidence of nerve root compression. Brachial plexopathy may be the direct cause of the reversible upper-limb paresis resulting from HZ with CRPS-like symptoms.

Topics: Acyclovir; Analgesics, Opioid; Antiviral Agents; Brachial Plexus Neuropathies; Brain; Complex Regional Pain Syndromes; Electric Stimulation Therapy; Electromyography; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paresis; Physical Therapy Modalities