Upper limb plexopathy secondary to herpes zoster: A PRISMA-guided systematic case review

OBJECTIVE: To systematically analyze published clinical cases of upper limb plexopathy secondary to herpes zoster (HZ) to clarify epidemiology, clinical features, diagnostic methods, treatments, and outcomes. BACKGROUND: Plexopathy caused by HZ is a rare neurological complication predominantly affecting older adults. Despite scattered case reports, knowledge gaps remain regarding its incidence, pathophysiology, management, and prognosis. This review addresses these gaps by synthesizing individual patient data with a rigorous methodology. METHODS: A systematic review adhering to PRISMA-IPD guidelines was conducted by searching PubMed, Scopus, and EMBASE from 2000 to 2025 for case reports and series of HZ-associated upper limb plexopathy published in English, Spanish, or French. Data extracted included demographics, clinical manifestations, electrophysiological and imaging findings, treatments, and outcomes. RESULTS: Sixty articles describing 123 patients (mean age 69.5 years, balanced sex distribution) met inclusion criteria. Most patients presented with mixed motor and sensory nerve involvement, primarily involving C5-C6 dermatomes. Common comorbidities included diabetes mellitus and immunosuppression. Treatment typically combined antivirals, neuropathic pain management, and rehabilitation. Complete recovery occurred in 47% of cases, partial improvement in most others, while 27% experienced persistent sequelae. Delayed diagnosis, immunosuppression, pure axonal EMG patterns, and age over 70 years were associated with worse outcomes. CONCLUSIONS: This PRISMA-IPD systematic review provides the most comprehensive synthesis to date on HZ-associated brachial plexopathy, emphasizing the importance of early clinical and electrophysiological diagnosis and multimodal treatment. Findings underscore the need for standardized diagnostic protocols and prospective studies to improve patient management and prognosis in this rare but disabling condition.