摘要
目的总结带状疱疹继发节段性肢体运动麻痹的临床特点及预后。方法对2018年1月至2019年1月于复旦大学附属华山医院诊治的3例带状疱疹继发节段性肢体运动麻痹患者进行报道,并对国内截至2019年1月报道的共计23例带状疱疹继发节段性肢体运动麻痹患者(包括新报道的3例)进行总结与分析。结果例1男性,72岁,右下肢皮肤(L4~5、S1)出现带状疱疹3 d后右足下垂,电生理检查提示腓总神经不全损害,予抗病毒、甲钴胺及糖皮质激素治疗,半年后足下垂恢复正常;例2女性,62岁,右肩及右上肢皮肤(C5~6)出现带状疱疹1周后右臂抬举困难,电生理检查提示腋神经不全损害,予甲钴胺及银杏叶制剂治疗,半年后肌力基本恢复正常;例3女性,86岁,左上肢及左侧前胸后背皮肤(C7~8、T1~3)出现带状疱疹2周后左手乏力,未行电生理检查,予甲钴胺及银杏叶制剂治疗,3个月后基本恢复正常。结论带状疱疹继发节段性肢体运动麻痹多发生于老年人,常在皮疹出现后的数周内出现。运动麻痹的节段与皮疹的节段相一致,上肢受累较下肢受累更常见。电生理检查常提示终末神经损伤。其预后相对良好,绝大部分患者可恢复功能正常。
Objective To describe clinical features and prognosis of segmental zoster paralysis of limbs.Methods Three patients with segmental zoster paralysis of limbs in Huashan Hospital from January 2018 to January 2019 were reported,and a total of 23 patients(including the presenting three patients)until January 2019 in China were summarized.Results Case 1:A 72-year-old man developed right foot drop three days after herpes zoster in the right lower limb(L4-5,S1).The electrophysiological study showed incomplete common peroneal nerve injury.He was treated with anti-virus drug,mecobalamine and steroids,and achieved a complete recovery after six months.Case 2:A 62-year-old woman developed difficulty raising the right arm one week after herpes zoster in the right shoulder and upper limb(C5-6).The electrophysiological study showed incomplete axillary nerve injury.He was treated with mecobalamine and ginkgo leaf preparation,and achieved an almost full recovery after six months.Case 3:A 86-year-old woman developed left hand weakness two weeks after herpes zoster in the left upper limb,chest and back(C7-8,T1-3).The electrophysiological study was not performed.She was treated with mecobalamine and ginkgo leaf preparation and got achieved an almost full recovery after three months.Conclusions Segmental zoster paralysis of limbs was most commonly seen in the elders,within weeks after rash eruptions.Focal motor paralysis appeared in the same segment where the skin eruptions occurred,with the upper limbs being more commonly affected than the lower ones.The electrophysiological study usually showed terminal nerve injuries.The prognosis was relatively good and most of the patients achieved functional recovery.
作者
杨仕林
董强
韩翔
Yang Shilin;Dong Qiang;Han Xiang(Department of Neurology,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China)
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2019年第11期904-911,共8页
Chinese Journal of Neurology
基金
上海市重中之重临床医学中心和重点学科建设计划项目(20178801014)。
关键词
疱疹
带状
麻痹
节段性运动麻痹
肢体运动麻痹
Herpes zoster
Paralysis
Segmental motor paralysis
Limb motor paralysis
