Zoster-associated limb paralysis mimicking acute stroke: a case report

Area of Science:

• Neurology
• Infectious Diseases
• Virology

Background:

• Varicella zoster virus (VZV), a Deoxyribonucleic acid (DNA) virus, causes herpes zoster upon reactivation.
• Herpes zoster typically manifests as vesicular eruptions in a dermatomal distribution.
• Peripheral motor neuropathy is an exceptionally rare complication of VZV reactivation.

Observation:

• A 57-year-old female presented with acute, painful left upper limb weakness following a febrile illness.
• Vesicular eruptions appeared in a dermatomal distribution corresponding to cervical nerves C5, C6, and C7.
• Electromyography indicated acute denervation of the C5, C6, and C7 myotomes.

Findings:

• The patient was diagnosed with zoster-associated brachial plexopathy.
• Treatment involved acyclovir, steroids, and analgesics.
• The patient experienced a significant recovery.

Implications:

• Brachial plexus neuritis secondary to varicella zoster infection is a crucial consideration in cases of acute limb monoparesis.
• Recognizing this treatable and reversible neurological complication can improve patient outcomes.
• This case highlights the importance of considering VZV reactivation in the differential diagnosis of acute peripheral neuropathies.