Motor paralysis of the lower extremities in herpes zoster

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SINCE antiquity, the cutaneous and sensory manifestations of herpes zoster have been known. It was called zona (girdle) by the ancient Greeks. Herpes zoster and motor paralysis rarely occur simultaneously. Weakness of the lower extremities is particularly unusual in patients who have herpes zoster.

We recently examined a patient whose presenting symptoms were acute sciatica and pain in the left lower extremity, and with a typical herpetic rash on the left buttock. Subsequently, sensory loss and motor paralysis of the left gastrocnemius-soleus group developed, with absence of the reflex of the left ankle. This rare complication of herpes zoster prompted us to review the medical writings, and to present a report of the case.

Review of Medical Writings

Historical aspects. In 1866, Broadbent1 published an account of motor involvement of the upper extremity, which he ascribed to herpes zoster. In 1876, Hardy2 reported a case of motor involvement in the lower extremity. Since then there have been many reports of motor involvement of the trunk muscles,3, 4 including the diaphragm5 and the trigeminal and facial nerves.6 Taterka and O’Sullivan,7 in a review of reports of motor paralysis in association with herpes zoster, found that the upper extremity was affected in 45.5 percent of patients, the trunk in 40.9 percent, and the lower extremity in 13.6 percent. The incidence of motor involvement was three times more common in men than in women, and almost always occurred in middle-aged or older persons. In 1961, in a review of medical writings, Grant and . . .



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