title: Herpes zoster virus: an unusual but potentially treatable cause of sciatica and foot drop.
abstract: The herpes zoster virus is a rare but potential cause of acute motor weakness. This article describes 2 patients with drop foot secondary to an infection of varicella zoster who were incorrectly referred to an orthopedic clinic from their general practitioners. The first patient was a 74-year-old man who presented with weakness in the right foot and a vesicular rash. The pattern of disease supported the clinical diagnosis of shingles affecting the L5 motor and sensory division. No investigation was required, and the patient was treated with a foot drop splint. The second patient was a 71-year-old man who presented with right leg and foot weakness and a vesicular rash affecting his right buttock and posterior right thigh. Lumbar magnetic resonance excluded a stenotic lesion; electrophysiological studies supported the diagnosis of a lower motor neuron lesion. The patient was treated with a 1-week course of acyclovir and a foot drop splint. The correct diagnosis will aid in correct referral and will prompt management, which will potentially provide a faster and better outcome for the patient.
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Walter B
authors.initials: WB
authors.lastname: Sprenger De Rover
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Alazzawi
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hallam
authors.forename: Rachael
authors.initials: R
authors.lastname: Hutchinson
authors.forename: Livio
authors.initials: L
authors.lastname: Di Mascio
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D004594:Electrophysiology; D005076:Exanthema / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D006562:Herpes Zoster / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014645:Herpesvirus 3, Human / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018908:Muscle Weakness / Q000175:diagnosis / Q000628:therapy / Q000821:virology; D012585:Sciatica / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D013165:Splints; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir