A Case of Unilateral Motor Paralysis: CASE REPORT

21 Jan
2011

A 55-year-old woman presented with a 10 day history of painful, grouped vesicles and paralysis of her left arm. She complained of a severe tingling pain in her left shoulder and arm over a 20 day period. The skin lesions were distributed along the left shoulder and arm (C4-C6 dermatome) (Fig. 1), and the patient could not raise or bend her left arm. There was no history of trauma to her left shoulder, arm, head, or neck region.

Table 1. Electromyography of muscles of the left upper limb

Muscles

Spontaneous

MUAP

Recruitment

IA

Fib

PSW

Fasc

Amp

Duration

PPP

Pattern

L. Abductor
pollicis brevis

N

None

None

None

N

N

N

N

L. Abductor digit
minimi

N

None

None

None

N

N

N

N

L. First dorsal
interosseous

N

None

None

None

N

N

N

N

L. Flexor carpi
radialis

Inc

1 +

1 +

None

N

N

N

N

L. Flexor carpi
ulnaris

N

None

None

None

N

N

N

N

L. Biceps

Inc


2+

3+

None

N

N


1 +

Markedly reduced

L. Triceps

N

None

None

None

N

N

N

N

L. Deltoid

Inc

1 +

2+

None

N

N

1 +

N

L. C5-6 PVM

N

None

None

None

N

N

N

N

L. C6-7 PVM

N

None

None

None

N

N

N

N

L. C7-T1 PVM

N

None

None

None

N

N

N

N

L. Extensor carpi
radialis longus

Inc

1 +

3+

None

N

N

1 +

N

L. Rhomboid minor

N

None

None

None

N

N

N

N

L. Rhomboid major

N

None

None

None

N

N

N

N

L. Supraspinatus

Inc

2+

3+

None

N

N

1 +

N

The patient was healthy except for a 2-year history of Diabetes mellitus. Physical examination revealed weakness of the flexion of the elbow (Grade 1/5), abduction (Grade 2/5) and flexion of the shoulder (Grade 2/5) (Fig. 2). Shoulder elevation motion was intact. Sensory examination revealed slight hypoesthesia in all the dermatomes from C4-C6. levitra professional

Simple X-ray of both shoulders and arms showed no evidence of a bony abnormality. A computed tomography of the head and neck was done and no defective or degenerative lesions were found.

fig1. grouped

Fig. 1. Grouped painful vesicles on the left shoulder and flexor area of the arm (dermatome C4-6).

Laboratory examination was within normal limits. Electromyography (Table 1) showed a decreased recruitment pattern from the biceps, and positive sharp waves and fibrillation potentials from the left deltoid, biceps, flexor carpi radialis, extensor carpi radialis longus and supraspinatus. In addition, a mo­tor nerve conduction velocity test showed delayed latency of the left median nerve. These find­ings were consistent with zoster-induced axonal degeneration in the left C5-6 upper trunk level of the brachial plexus.

fig2. ab incapacity

Fig. 2. (А, В) Incapacity of flexion of the left elbow, abduction and flexion of the left shoulder.

The patient was treated with intravenous acyclo­vir, analgesics and topical antibiotic ointment for 7 days and got physical therapy. On discharge, her skin lesions had almost improved. She received physical therapy at the local orthopedic clinic for 6 months, and the weakness in her left shoulder and arm got somewhat better.
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