*Extracranial Herpetic Paresis DOI: http://dx.doi.org/10.5772/intechopen.90493*

**Literature**

**48**

**medical history**

[14]

 58-year old. female

 Rash in left shoulder, lateral part of left arm

and hand; pain in neck

and region

[15]

 #1: 82-year old female

 Pain and rash in right

Weakness in proximal

Denervation

biceps, polyphasia and

decreased number of

MUAP

Denervation

all arm muscles; ulnar

and median conduction

velocities reduced Marked denervation

 Not reported

 Heat, electrical

Functional recovery

within 6 weeks

stimulation,

strengthening

 exercises

 in almost

Not reported

 B12 injections, heat,

Incomplete

 recovery

*Human Herpesvirus Infection - Biological Features,Transmission, Symptoms, Diagnosis*

paraffin baths,

exercises

Weakness in biceps, deltoid, wrist flexors/

extensors

supraspinatus;

 in deltoid,

Moist hot packs,

Incomplete

 recovery

ultrasound,

 exercise

arm mild elbow flexion

contracture

shoulder and upper

arm

#2: 72-year old female,

breast carcinoma with

mastectomy

#3: 65-year old female

Pain and rash in right

Weakness in deltoid, biceps, triceps, wrist

extensors, thenar

muscles

Weakness in deltoid,

Denervation;

MUAP

 polyphasic

Not reported

 Heat, electrical

Some recovery of

strength and less pain

stimulationsling

infraspinatus,

supraspinatus,

Weakness in deltoid,

Denervation

muscles

 in C7–8/T1

Not reported

 Codeine, whirlpool,

Nearly complete

recovery after

unknown time period

paraffin baths

biceps, wrist flexors/

extensors

Weakness in arm;

Denervation

and biceps muscles

 in deltoid

Unremarkable

X-ray and laboratory

work-up

 chest

Physical therapy

 Full recovery after

3 weeks

*…*

reflexes absent in biceps, supinator

 biceps

arm

with knee amputation

for vascular disease,

chronic leukemia

#4: 62-year old female,

Pain and rash in right

arm

rheumatoid

#5: 71-year old female

[16]

 #1: 70-year old female

 Pain in left shoulder with radiation to arm,

hyperesthesia

shoulder and neck;

rash in C4–5 dermatomes

 in

 Pain and rash in right

shoulder and forearm

 arthritis

interscapular

**Demographics,**

**Subjective**

**Neurological**

**EMG findings**

 **Other tests**

**Treatment**

Exercises

After 2 months,

power and mass of

M. deltoideus

increase

**Course/Outcome**

**impairments**

Weakness of left shoulder, wasting of left

*M. deltoideus*

**complaints**


**Literature**

**51**

**medical history**

[24]

 59-year old-female

with carcinoma

mammae dextri and

lung metastasis,

chemotherapy

radiotherapy

**Table 1.**

*List of studies that reviewed herpes zoster infection and motor paresis of only upper limbs.*

 and

**Demographics,**

**Subjective**

**Neurological**

**EMG findings**

 **Other tests**

**Treatment**

**Course/Outcome**

**impairments**

Patient was able to

EMNG-low

action potentials in left

superior radial and

median, SNAPs and

MUAPs in left deltoid

muscle

 amplitude

Positive direct

Acyclovir 10 mg/

Motor activities recovered after

5 months with

*Extracranial Herpetic Paresis*

physiotherapy

postherpetic

had a poor decrement

 neuritis

*DOI: http://dx.doi.org/10.5772/intechopen.90493*

 but

fluorescent

test for VZV, neck

MRI-C4-C5-C6

protruded disk

 levels

 antibody

8 hours i.v. for 7 days

adduct shoulder, flexor

and extensor wrist and passively extend elbow

**complaints**

Pain and rash in whole

right arm and scapula


 *List of studies that reviewed herpes zoster infection and motor paresis of only*

 *upper limbs.*

## *Extracranial Herpetic Paresis DOI: http://dx.doi.org/10.5772/intechopen.90493*

**Literature**

**50**

**medical history**

[7]

 72-year old man with

oral

to myasthenia

[20]

 73-year old man

 Right shoulder pain

and herpes zoster

eruptions over the C5

dermatome

[21]

 A 48-year old female

 Rash and vesicles over

Weakness in the left

Chest CT normal,

1000 mg valacyclovir

The patient's pain

*Human Herpesvirus Infection - Biological Features,Transmission, Symptoms, Diagnosis*

resolved three months

later, and the patient

underwent

follow-up for 2 years

without further

complications

 outpatient

MRI-hyperintensity

orally three times daily

for 7 days.

in the left anterolateral

of the spinal cord at

C5 level

 aspect

deltoids and biceps

muscles, and a

diminished

reflex; dyspnea with

paradoxical

wall movement

Hyperalgesia

C4–T2 shoulder abduction

weakness

dermatomes,

 left

left biceps, deltoid,

brachioradialis

6 paraspinal muscles;

sensory and motor

nerve-conduction,

somatosensory

potentials are normal

[23]

 88-year old man with

Rash in the right C3–5

Paresis in the right shoulder 2 days after the

rash

dermatome

corticosteroids

therapy because of

polymyalgia

rheumatica

 in

 evoked

 and

 and C5–

changes with

foraminal stenosis at

C3–T1

 skin in left

EMG-denervation

 in

MRI of cervical

750mg/d famciclovir

After 2 months, pain

and weakness were

significantly

 retracted

spine-degenerative

per os, cervical epidural

blocks with 20mg

triamcinolone

during 4 weeks, 450mg

pregabalin and 10mg

nortriptyline,

physiotherapy

Oral valaciclovir,

Paresis has gradually

improved

*…*

acyclovir iv after

paresis and

methylprednisolone

 twice

[22]

 A 72-year old female

 Burning pain and rash

in the left shoulder and

its weakness

 abdominal

 left biceps

her left C5–7

dermatomes

 gravis

prednisolone

 due

dermatomes

Rash in left C3–5

10 days before the rash,

T2-weighted

 MRI

> weakness of the left arm

limited to muscles controlled by the C5

myeloma

Two days later, he

found it impossible to

lift up the right arm

**Demographics,**

**Subjective**

**Neurological**

**EMG findings**

 **Other tests**

**Treatment**

**Course/Outcome**

**impairments**

diminished

 in biceps,

brachioradialis

 muscle

**complaints**


**Literature**

**53**

**medical history** #5. 73-year old man

 Pain and rash in right shoulder and in upper

arm

Rash over left thigh

 Weakness of hip

Not reported

Not reported

Not reported

Full recovery after

4 months

*DOI: http://dx.doi.org/10.5772/intechopen.90493*

flexors, adductors,

knee extensors Weakness in left arm

 Not reported

Not reported

Hydrotherapy,

Full recovery

> physical therapy

Intensive

Full recovery in arm,

residual pain after

5 months

physiotherapy

#6. 74-year old

woman

#7. 73-year old man

#8. 81-year old female Pain and rash over

#9. 75-year old female Rash of outer part of

[27]

 #1. 73-year old female Rash in right C4–7

dermatomes;

segmental severe

paresis in C6, 7, 8

Rash in right C5–7

Moderate weakness in

Denervation

CSF normal;

Supportive

 treatment

 Full recovery after

9 months

myelogram

 normal

C5–7 myotomes Moderate weakness in

Denervation

Not reported

Supportive

 treatment

 Full recovery after

3 months No recovery, died

6 years later

C5–6 myotomes

Weakness in

Fibrillations

flexors, vastus medialis

 in hip

Not reported

Not reported

> quadriceps and hip

adductors, and flexors; reflexes absent in knee

dermatomes

#2. 78-year old

female, diabetes

#3. 67-year old man

[28]

 #1. 84-year old man

 Pain and rash in right

L2–3 impaired sensation in

L2–3

dermatomes

dermatomes;

 Rash in left C5–6

dermatomes

right arm

 Rash over left shoulder and upper third of arm

C1–7

dermatomes

Weakness of right

Not reported

Not reported

> serratus anterior,

scapula winging Weakness in shoulder

Not reported

Not reported

Intensive

Full recovery after

5 months; some pain

persisted

physiotherapy

flexors and abductors,

and in elbow flexors Denervation

CSF normal;

Supportive

 treatment

 Full recovery after

7 months

myelogram

 normal

**Demographics,**

**Subjective complaints**

**Neurological**

**EMG findings**

 **Other tests**

**Treatment**

**Course/outcome**

**impairments**

Weakness in shoulder

Not reported

Not reported

Intensive physical

Full recovery after

7 months

*Extracranial Herpetic Paresis*

therapy

with deltoid fasciculations


### *Extracranial Herpetic Paresis DOI: http://dx.doi.org/10.5772/intechopen.90493*

**Literature**

**52**

**medical history**

[25]

 #1: 89-year old man,

Pain and rash in right

thigh and knee

transient facial weakness 1 year

earlier, 6 months earlier

#2. 44-year old female Pain and rash over

right distal arm in C7–8

dermatome

#3. 74-year old

Pain and rash in T12-L1

dermatomes

woman

#4. 58-year old

Pain in left leg and rash

over S1–2

dermatomes

extensors, ankle

dorsiflexors

plantar flexors; reflexes

absent in left leg

Weakness in forearm

Not reported

Not reported

Physical therapy

 Return of strength but

impaired fine

movements

and hand muscles

 and

woman, diabetes

[26]

 #1. 71-year old female Rash along right ulnar

border of forearm and

hand

shoulder and arm

Weakness in complete

Not reported

Not reported

Physical therapy

 Full recovery except

in deltoid muscle, neuralgia over 3 years

Weakness in deltoid and biceps; neuralgia

over 8 months

right arm, reflex absent

in biceps Weakness in deltoid,

Not reported

Not reported

Hydrotherapy,

exercises

biceps; reflexes absent

in biceps Weakness in deltoid,

Not reported

Not reported

Physical therapy

 Incomplete residual neuralgia died after 7 months

 recovery,

supraspinatus

reflex diminished

triceps

 biceps;

 in

#2. 76-year old female Rash over right #3. 83-year old female Pain and rash over

#4. 85-year old

Pain and rash in left

shoulder

woman

right shoulder

conjunctivitis

**Demographics,**

**Subjective complaints**

**Neurological**

**EMG findings**

 **Other tests**

**Treatment**

**Course/outcome**

**impairments**

Weakness and atrophy

Denervation

*quadriceps*,

anterior, peroneus

 tibialis

 in *M.*

X-ray: changes in LS spine

degenerative

Physical therapy,

Incomplete

after 3 months

 recovery

> galvanic electrical

stimulation

in right thigh, decreased sensation;

reflexes diminished

knees and ankles Weakness of proximal

and distal muscles of

right arm

Bulging of right

abdomen and decreased muscle tone

Weakness in left knee

Not reported

Not reported

Not reported

Able to walk after

5 weeks

*Human Herpesvirus Infection - Biological Features,Transmission, Symptoms, Diagnosis …*

 in

longus and

gastrocnemius

Fibrillations

upper arm in C8

myotome

Not reported

Not reported

Corset

Not reported

 in right

Not reported

Physical therapy

 Incomplete

 recovery


**Literature**

**55**

**medical history** #8. 73-year old man

 Pain around knee, rash

in medial aspect of left

thigh

#9.69-year old man

 Pain in right axilla, rash

in medial arm and medial aspects of two

fingers

[29]

 #1. 77-year old man

#2. 57-year old man

Pain and rash over

Weakness in right hip,

Denervation

iliopsoas, quadriceps, tibial, F waves reduced

in frequency

 in

Blood tests normal; CSF increased protein

and cell count; VZV

antibodies IgG and

IgM positive; lumbar

spine MRI normal

Cervical spine MRI

normal

thigh muscles, ankle

dorsiflexors,

reflex diminished

 patellar

right wrist and groin

unable to walk

with diabetes #3. 65-year old female Pain and rash in left

shoulder and arm C5–6

Weakness in shoulder,

Reduced interference

with denervation

deltoid and C5

paraspinals

Denervation,

polyphasia,

conduction

 velocity

 normal

 muscles

 in

reflexes diminished

dermatomes

[11]

 #1.84-year old man

with syndrome

myelodysplastic

R C5,6

Weakness in C5,6 and

atrophia

 Pain and rash in left

Weakness in shoulder,

biceps, triceps, and

wrist extensors muscles

shoulder

**Demographics,**

**Subjective complaints**

**Neurological**

**EMG findings**

 **Other tests**

**Treatment**

**Course/outcome**

**impairments**

Wasting and moderate

Fibrillations

reduced interference

pattern, polyphasic

units

 slightly

Not reported

Not reported

Full recovery after

4 months

*Extracranial Herpetic Paresis*

weakness in

quadriceps;

diminished

Weakness in hand

Fibrillations

and reduced interference

 pattern,

 polyphasia

Not reported

Not reported

Marked wasting and

weakness in thenar,

*DOI: http://dx.doi.org/10.5772/intechopen.90493*

hypothenar,

intrinsic muscles after

1 year

 and

intrinstics, sensory

impairment

and T2 absent reflexes

 in C8, T1

dermatomes;

reduced motor velocity

in ulnar nerve, absent

sensory neurograms

Denervation

and biceps, reduced

MUAP recruitment

 in deltoid

Routine lab normal;

Valacyclovir

7 days, Acyclovir iv

750 mg for 7 days, Methylprednisolone

500 mg for 3 days, Prednisol 60 mg and

tapering

Acyclovir 750 mg for

Full recovery after

3 months

7 days, Acyclovir iv

750 mg for 7 days, Methylprednisolone

1000 mg for 3 days,

Prednisolone

Valacyclovir

 3 g

 Marked recovery after

3 months Moderate recovery

after 6 months

 60 mg

 iv

 iv

 3 g for

Full recovery after

1 year

CSF increased protein,

normal cell count; VZV antibodies IgG positive IgM negative;

cervical spine MRI

normal

 at the knee

 reflex


### *Extracranial Herpetic Paresis DOI: http://dx.doi.org/10.5772/intechopen.90493*

**Literature**

**54**

**medical history**
