acyclovir and Muscle-Weakness

A 72-year-old woman presented with acute-progressive muscle weakness after a rash in the left upper limb. Muscle weakness was restricted to the left C5 innervated muscles. Short inversion time inversion recovery magnetic resonance imaging (MRI) showed a high-intensity signal in the left C5 nerve root, and nerve ultrasound showed its enlargement. She was diagnosed with segmental zoster paralysis (SZP) and treated with acyclovir and methylprednisolone. Her muscle strength gradually recovered, and the abnormal signal and enlargement in the left C5 nerve root improved. This is the first SZP case of confirmed improvement of abnormal findings on MRI and nerve ultrasound in association with muscle power recovery.

Topics: Acyclovir; Aged; Female; Herpes Zoster; Humans; Magnetic Resonance Imaging; Muscle Weakness; Paralysis; Paresis

Cranial polyneuropathy is commonly caused by Lyme disease. We discuss the case of a man who presented with cranial nerve deficits causing dysphagia, dysphonia and facial weakness. This diagnostic dilemma stemmed from a workup that ruled out Lyme and vascular causes leading to an expanded search for infectious explanations, which revealed varicella zoster in the cerebrospinal fluid. On review, this phenomenon is rarely reported, but has been observed with a number of herpes family viruses. In emergency department settings, clinical suspicion should be raised for VZV infection even in the absence of rash in patients that present with multiple cranial nerve palsies.

Topics: Acyclovir; Antiviral Agents; Cranial Nerve Diseases; Deglutition Disorders; Dysphonia; Emergency Service, Hospital; Facial Muscles; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Muscle Weakness; Polyneuropathies

This is a rare case of Varicella zoster virus (VZV) lumbosacral plexopathy in an 84-year-old women presenting with lower limb weakness and rash. Contrast-enhanced MRI showed enhancement of the left L3-L5 descending nerves and left lumbosacral plexus consistent with inflammatory/infectious aetiology. Cerebrospinal fluid PCR confirmed VZV DNA and cerebrospinal fluid serological testing was positive for VZV immunoglobulin (Ig)M and IgG antibodies. The patient was treated with intravenous acyclovir but this was complicated by the development of acute renal failure attributed to acyclovir-induced nephropathy, requiring dose adjustment. After a prolonged course of oral acyclovir and inpatient rehabilitation, the patient made a partial neurological and functional recovery.

Topics: Accidental Falls; Acyclovir; Aged, 80 and over; Antiviral Agents; Female; Herpesvirus 3, Human; Humans; Lower Extremity; Lumbosacral Plexus; Muscle Weakness; Peripheral Nervous System Diseases; Spinal Cord Compression; Varicella Zoster Virus Infection

Topics: Acyclovir; Adolescent; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Cough; Diagnosis, Differential; Disorders of Excessive Somnolence; Encephalomyelitis, Acute Disseminated; Fever; Humans; Male; Muscle Weakness

We describe a patient with zoster paresis and an MRI that revealed extensive spinal cord lesions from the upper cervical to the lower thoracic spinal cord. Importantly, the patient reported considerable spontaneous improvement in strength 2-3 weeks after zoster. This report reveals a previously undescribed remarkable preponderance of MRI lesions far beyond the site of zoster rash and focal lower motor neuron weakness.

Topics: Acyclovir; Aged; Antiviral Agents; Exanthema; Female; Herpes Zoster; Humans; Magnetic Resonance Imaging; Motor Neuron Disease; Muscle Weakness; Spinal Cord; Spinal Nerve Roots; Valacyclovir; Valine

The herpes zoster virus is a rare but potential cause of acute motor weakness. This article describes 2 patients with drop foot secondary to an infection of varicella zoster who were incorrectly referred to an orthopedic clinic from their general practitioners. The first patient was a 74-year-old man who presented with weakness in the right foot and a vesicular rash. The pattern of disease supported the clinical diagnosis of shingles affecting the L5 motor and sensory division. No investigation was required, and the patient was treated with a foot drop splint. The second patient was a 71-year-old man who presented with right leg and foot weakness and a vesicular rash affecting his right buttock and posterior right thigh. Lumbar magnetic resonance excluded a stenotic lesion; electrophysiological studies supported the diagnosis of a lower motor neuron lesion. The patient was treated with a 1-week course of acyclovir and a foot drop splint. The correct diagnosis will aid in correct referral and will prompt management, which will potentially provide a faster and better outcome for the patient.

Topics: Acyclovir; Aged; Antiviral Agents; Electrophysiology; Exanthema; Gait Disorders, Neurologic; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Muscle Weakness; Sciatica; Splints; Treatment Outcome

Segmental zoster paresis of the left upper limb in a pediatric patient.Segmental zoster paresis is a rare complication of herpes zoster characterized by focal, asymmetrical motor weakness in the myotome that corresponds to the dermatome of the rash. Segmental zoster paresis typically develops within 2-3 wks of cutaneous zoster and predominantly affects the middle-aged and elderly populations. Motor complications rarely develop in children and young adults, but when they do develop, involvement is usually confined to cranial and truncal muscles, with sparing of the limb musculature. A 10-yr-old boy with Fanconi's anemia developed left upper limb weakness because of involvement of C5 motor roots as a complication of herpes zoster. Recognizing motor zoster as a cause of acute motor weakness in a pediatric patient is important in avoiding unnecessary interventions and optimizing treatment.

Topics: Acyclovir; Antiviral Agents; Child; Electromyography; Herpes Zoster; Humans; Male; Muscle Weakness; Neural Conduction; Occupational Therapy; Paresis; Physical Therapy Modalities; Upper Extremity

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

Topics: Acyclovir; Antiviral Agents; Cervical Vertebrae; Ganglia, Spinal; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Muscle Weakness; Radiculopathy; Spinal Nerve Roots; Spondylosis; Tomography, X-Ray Computed; Virus Activation

Segmental zoster paresis is a relatively rare complication characterized by focal motor weakness, which may occur in limbs affected by herpes zoster. We demonstrate the clinical characteristics of segmental zoster paresis by reviewing the cases of 138 patients, including 3 of our patients.. We report 3 patients with zoster paresis of the limbs. Patients 1 and 3 showed motor weakness in the left shoulder and arm after developing a herpetic rash in the left C5-C6 dermatomes. Patient 2 showed weakness in the right thigh and groin after a right L2-L3 herpetic eruption. The electromyograms of all 3 patients showed abnormal spontaneous activity in the affected muscles. Intravenous acyclovir and corticosteroid pulse therapy were added to oral antiviral drugs for patients 1 and 2. All 3 patients recovered favorably. Our review of the literature revealed that antiviral treatment may prevent the occurrence of zoster paresis; however, there is insufficient evidence to show what treatment hastens recovery from zoster paresis.. Segmental zoster paresis is still underrecognized by neurologists. Awareness of this disorder is important because it may eliminate unnecessary invasive investigations and lead to appropriate treatment. Further studies on the treatment are necessary.

Topics: Acyclovir; Aged; Antiviral Agents; Diabetes Complications; Electromyography; Exanthema; Female; Herpes Zoster; Humans; Lower Extremity; Magnetic Resonance Imaging; Male; Middle Aged; Muscle Weakness; Neural Conduction; Paralysis; Risk Factors; Skin; Upper Extremity