From the Guidelines
Lower brachial plexopathy associated with herpes simplex virus (HSV) is primarily caused by viral invasion and inflammation of the lower brachial plexus nerves, particularly affecting the C8-T1 nerve roots that form the lower trunk, as a result of reactivation during periods of immunosuppression, stress, or trauma 1. The condition often begins with the virus establishing latency in sensory ganglia, then reactivating to cause direct neural damage through cytopathic effects and triggering an inflammatory response that leads to demyelination and axonal injury. Key factors contributing to the development of lower brachial plexopathy in the context of HSV include:
- Immunocompromised state, which can increase the frequency, severity, and extent of herpes simplex infections 1
- Reactivation of latent HSV, potentially due to stress, trauma, or immunosuppressive therapy
- Direct viral invasion of the brachial plexus nerves, leading to inflammation and neural damage Patients typically present with acute onset of pain in the shoulder, arm, or hand, followed by weakness and sensory changes in the ulnar nerve distribution. Treatment and management strategies should focus on:
- Antiviral medications, such as acyclovir or valacyclovir, to reduce viral replication and inflammation
- Pain management using medications like gabapentin or pregabalin
- Physical therapy to maintain range of motion and prevent contractures during recovery.
From the Research
Causes of Lower Brachial Plexopathy Herpes Simplex
There are no research papers to assist in answering this question as the provided studies are related to herpes zoster, not herpes simplex.
Related Information on Herpes Zoster
- Herpes zoster, also known as shingles, is a viral disease characterized by painful skin eruptions and neuropathic sensory symptoms 2.
- Reactivation of dormant varicella zoster virus (VZV) in the dorsal root ganglia can cause herpes zoster 3.
- Brachial plexopathy is a rare complication of herpes zoster, with few reported cases in the literature 3, 4, 5.
- Motor involvement and brachial plexus involvement in herpes zoster are rare conditions 2.
- Treatment options for herpes zoster brachial plexopathy include antiviral medication, pain therapy, and palliative and supportive modalities, such as direct steroid injection onto the brachial plexus 2.
Diagnosis and Imaging
- MRI findings of zoster-induced brachial plexopathy have rarely been described, but can provide valuable information for evaluating the location and extent of lesions 5.
- MRI of the brachial plexus can demonstrate T2 hyperintensity and contrast enhancement in the affected area, reflecting the functional impairments more accurately than electrophysiological studies in the acute phase 5.