Subacute Brachial Radiculoplexitis Following Herpes Zoster Infection

Jae-Hwan Kim; Yong-Duk Kim; Sang-Jun Na; Kee Ook Lee; Bora Yoon

doi:10.14253/KJCN.2015.17.2.86

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

Original Article

Korean J Community Nutr 2015;17(2):86-90.

Published online: 18 December 2015

DOI: https://doi.org/10.14253/KJCN.2015.17.2.86

Subacute Brachial Radiculoplexitis Following Herpes Zoster Infection

Jae-Hwan Kim, Yong-Duk Kim, Sang-Jun Na, Kee Ook Lee, Bora Yoon

Department of Neurology, Konyang University College of Medicine, Daejeon, Korea

Address for correspondence; Bora Yoon Department of Neurology, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea, Tel: +82-42-600-9156 Fax: +82-42-545-0050 E-mail: boradori3@kyuh.ac.kr

Received 21 May 2015 Revised 28 August 2015 Accepted 7 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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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Keywords: Brachial plexopathy, Brachial radiculoplexitis, Herpes zoster

REFERENCES

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4.Tsairis P., Dyck PJ., Mulder DW. Natural history of brachial plexus neuropathy. Report on 99 patients. Arch Neurol. 1972. 27:109–117.

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6.Ayoub T., Raman V., Chowdhury M. Brachial neuritis caused by varicella-zoster diagnosed by changes in brachial plexus on MRI. J Neurol. 2010. 257:1–4.

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8.Eyigor S., Durmaz B., Karapolat H. Monoparesis with complex regional pain syndrome-like symptoms due to brachial plexopathy caused by the varicella zoster virus: a case report. Arch Phys Med Rehabil. 2006. 87:1653–1655.

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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).

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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.

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