Journal List > Korean J Clin Neurophysiol > v.17(2) > 1084167

Kim, Kim, Na, Lee, and Yoon: Subacute Brachial Radiculoplexitis Following Herpes Zoster Infection

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. (Korean J Clin Neurophysiol 2015;17:86-90)

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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).
kjcn-17-86f1.tif
Table 1.
Nerve conduction study, electromyography of case 1 and case 2 at 10 days after the onset of motor weakness
Case 1
Motor Latency (R/L) (ms) CMAP (R/L) (mV) NCV (R/L) (m/s)
Axillary 11.4/3.8 0.6/6.0
Musculocutaneous 5.6/4.8 4.0/7.6
Sensory Latency (R/L) (ms) SNAP (R/L) (µV) NCV (R/L) (m/s)
Lateral antebrachial cutaneous 4.1/2.3 37.4/23.6 34/52
Medial antebrachial cutaneous 1.7/1.7 20.7/20.7 50/52
Muscle (R) Nerve Root Fib/Psw
FlexCarRad Median C6-7 1+
BrachioRad Radial C5-6 1+
Biceps Musculocutaneous C5-6 1+
Supraspinatus Suprascapular C5-6 1+
Infraspinatus Suprascapular C5-6 1+
Deltoid Axillary C5-6 1+
Case 2
Motor Latency (R/L) (ms) CMAP (R/L) (mV) NCV (R/L) (m/s)
Median Wrist 3.8/4.1 7.2/8.7 54.0/47.0
Elbow 8.0/8.6 6.6/8.0 61.0/64.0
Axillary 9.9/10.2 6.7/8.1
Axillary 4.3/4.5 2.0/0.2
Sensory Latency (R/L) (ms) SNAP (R/L) (µV) NCV (R/L) (m/s)
Median Palm 2.3/2.3 23.4/19.3 31.0/24.0
Wrist 3.1/2.8 15.2/10.1 40.0/36.0
Elbow 3.8/3.7 27.4/15.8 51.0/51.0
Axillar 2.2/2.1 38.2/94.8 50.0/50.0
Radial 2.4/2.2 35.9/16.3 44/42
Muscle (L) Nerve Root Fib/Psw
FlexCarRad Median C6-7 1+
Pronator Teres Median C6-7 1+
BrachioRad Radial C5-6 1+
Biceps Musculocutaneous C5-6 1+
Deltoid Axiallary C5-6 1+

NCV; nerve conduction velocity, R; right, L; left, CMAP; compound muscle action potential, SNAP; sensory nerve action potential, FlexCarRad; flexor carpi radialis, BrachioRad; brachioradialis, Fib; fibrillation potential, Psw; positive sharp wave.

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.
kjcn-17-86f2.tif
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