Occurrence of Segmental Zoster Paresis in the Right Arm of an Adult with Multiple Sclerosis: A Case Report

多發性硬化症病患之右上臂皰疹性輕癱：病例報告

林詩涵(Shih-Han Lin) ； 陳文翔(Wen-Shiang Chen)

《台灣復健醫學雜誌》 37卷1期 (2009/03) Pp. 39-43

https://doi.org/10.6315/2009.37(1)04

摘要

皰疹性輕癱是帶狀皰疹感染較少見的後遺症，它的臨床特徵是與帶狀皰疹發疹皮節相對應肌節的運動麻痺。我們報告一個45歲的視神經脊髓型多發性硬化症患者，在右側頸第五、六皮節帶狀皰疹發疹後，發生右肩無力。鑑別診斷包括多發性硬化症復發、帶狀皰疹脊髓炎、皰疹性輕癱與肩部或頸椎附近肌肉骨骼系統的病變。發病一週後的磁振造影檢查並未在脊髓發現新的多發性硬化症斑塊或不正常的顯影，而右肩軟組織超音波也沒有發現骨骼肌肉系統病變。發病三週後的針極肌電圖檢查顯示右三角肌、肱二頭肌與頸椎第四到第七節椎邊肌有自發性活動電位，這與患者因肌節受皰疹感染而導致頸神經根病變的症狀相吻合，因此皰疹性輕癱導致右肩無力爲這個患者最可能的診斷。除了早期抗病毒藥物的給予外，我們爲患者安排積極的肌肉強化運動與關節活動。發病二個月後追蹤病人的復原情形，她的右肩帶肌力雖未恢復到發病前的狀態，但幾乎可以從事大部分的功能性活動。皰疹性運動麻痺是一個在臨床上鑑別診斷肢體無力常被忽略的病因，而針極肌電圖是輔助診斷、預測預後與追蹤復原情形的良好工具。提高臨床診斷率並及早投予抗病毒藥物治療能加快復原的速度，早期復健能促進病人的功能性恢復。

關鍵字

多發性硬化症 ； 帶狀皰疹 ； 皰疹性輕癱

並列摘要

Segmental zoster paresis is a rare complication of cutaneous herpes zoster. Clinical diagnosis of segmental zoster paresis depends upon a history of painful vesicular eruptions in a dermatomal distribution, followed by muscle weakness in the related myotomes. We report the case of a 45-year-old woman with opticospinal type multiple sclerosis with recent cutaneous herpes zoster and right shoulder girdle weakness. Differential diagnosis included multiple sclerosis relapse, zoster myelitis, segmental zoster shoulder paresis, cervical radiculopathy, and shoulder joint or soft-tissue disorders. MRI with gadolinium enhancement of the spinal cord 1 week after the onset of symptoms showed neither new multiple sclerosis plaque nor abnormal contrast-enhanced lesion. Right shoulder soft-tissue sonography revealed normal joint and soft tissue. Needle electromyography 3 weeks after the onset of weakness indicated increased spontaneous activity at the right biceps, anterior deltoid, and C4-C7 paraspinal muscles, as well as increased polyphasic waves at the right biceps muscle. These findings were compatible with recent right cervical polyradiculopathies involving at least the C4 to C7 levels. Therefore, the most likely etiology for her right shoulder girdle weakness was segmental zoster paresis. The patient received early antiviral therapy and intensive rehabilitation. Two months later, her shoulder muscle strength improved although it hadn't recovered to her premorbid status. The functional recovery in her right upper limb was good. Segmental zoster paresis is underdiagnosed in patients with segmental weakness. Needle electromyography is a good tool for assisting diagnosis and prognosis and for following up motor recovery. With early diagnosis, antiviral therapy and rehabilitation therapy can hasten neurological and functional recovery.

並列關鍵字

multiple sclerosis ； herpes zoster ； segmental zoster paresis