Abstract Details

Title MRI negative Varicella zoster virus (VZV) plexopathy in a young man with history of malignancy

Topic General Neurology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 12-001

Objective To emphasize the importance of including VZV plexopathy in differential diagnosis in young individuals and to prevent the delay in diagnosis and treatment

Background VZV-associated plexopathy in mainly patients over 60 years old. Post herpetic neuralgia is a well-known complication of Herpes Zoster (HZ), however segmental zoster paresis secondary to HZ was reported in 1-20% of the cases in literature. MRI findings may be positive in up to 70% of the patients.

Design/Methods N/A

Results 43 years-old man with history of grade 2 left frontal oligodendroglioma which was treated with 2 partial resections, radiation and adjuvant procarbazine/lomustine presented with left upper extremity pain and developed a blistering rash in dermatomal pattern in left proximal upper extremity 2 weeks after the initial symptoms. He was diagnosed with shingles and treated with steroids and acyclovir with minimal improvement. 6 weeks after presentation, physical exam revealed left deltoid, supraspinatus and infraspinatus weakness with normal muscle stretch reflexes and decreased sensation on C5 dermatome. EMG revealed absent left lateral antebrachial cutaneous sensory nerve action potentials (SNAP) amplitude, and a small left radial SNAP amplitude compared to the right side. Evidence of ongoing denervation with reinnervation was seen in the left upper trunk supplied muscles. MRI of the brachial plexus was negative for any abnormalities. Patient was diagnosed with VZV-associated plexopathy, improved with pregabalin and physical therapy.

Conclusions Our patient was significantly younger than expected in HZ group. MRI usually shows T2 hyperintensities and thickening of the nerve roots in patients with VZV-associated plexopathy. However, the presentation, onset of symptoms, characteristics of the rash and clinical course was diagnostic of HZ, and the weakness pattern, supported by the EMG findings were diagnostic for VZV-associated plexopathy.

Authors/Disclosures
Sedat Gul, MD PRESENTER	Dr. Gul has nothing to disclose.
Adeenah Ahmed, MD	Ms. Ahmed has nothing to disclose.
Corey A. McGraw, MD (Upstate Medical University)	The institution of Dr. McGraw has received research support from Novartis. The institution of Dr. McGraw has received research support from F. Hoffmann - La Roche. The institution of Dr. McGraw has received research support from Genentech. The institution of Dr. McGraw has received research support from Neurona Therapeutics. The institution of Dr. McGraw has received research support from Instituto Grifols, S.A..
Ruham Alshiekh Nasany, MD	Dr. Alshiekh Nasany has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for J&J.

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