Idiopathic bilateral diaphragmatic paralysis

Abstract

A 41-year-old man complained of subacute onset of dyspnea and pain in the neck and chest. He was diagnosed with bilateral diaphragmatic paralysis, based on clinical inspection of the breathing pattern and transdiaphragmatic pressure recording, and was trained to use a portable bi-level positive airway pressure apparatus (BiPAP). Needle electromyography showed profuse fibrillation potentials and positive waves in the diaphragm, more abundant on the right than left side, and no response to phrenic nerve stimulation. Other muscles were not involved. Follow-up examinations, performed at 9 and 12 months after onset of paralysis, demonstrated a slow but progressive improvement of the patient's respiratory function, together with the appearance of reinnervation potentials in the diaphragm, and polyphasic, long-latency responses to phrenic nerve stimulation. The subacute onset of the paralysis associated with local pain, and its subsequent recovery, suggest bilateral proximal lesions in the phrenic nerves. In the absence of traumatic or metabolic causes, these findings suggest that the phrenic nerve can be a target in idiopathic neuritis.

Brachial Neuritis With Bilateral Diaphragmatic Paralysis Following Herpes Zoster: A Case Report

“…The utility of needle electrode examination has been described in patients with diaphragm paralysis showing increased needle insertional activity and positive waves. [13][14][15] Our patient's bilateral absence of phrenic nerve CMAP responses could not be further substantiated by diaphragmatic electromygram abnormalities.…”

A 54-Year-Old Man with Acute Onset Orthopnea and Sleep-Related Hypoxia

“…1,2 The differential diagnoses for this patient's subacutely evolving bilateral diaphragmatic weakness included bilateral isolated phrenic neuropathy (BIPN), [3][4] neuralgic amyotrophy ([NA] also known as Parsonage-Turner Syndrome), [5][6][7] and amyotrophic lateral sclerosis. There was no evidence for other conditions which may rarely cause bilateral phrenic neuropathies, such as diabetes, 8 multifocal motor neuropathy with conduction block, 9 POEMS syndrome, 10 sarcoidosis, 11 arsenic poisoning, 12 prior irradiation, 13 or acid maltase deficiency.…”

“…14 BIPN presents as a painless paralysis of the diaphragm with relatively acute onset, and without antecedent factors such as infection or prior surgery. [2][3][4] NA is a distinct and painful brachial plexus neuropathy causing patchy, multifocal paresis and sensory loss in one or both arms, with rare involvement of the phrenic nerves. [5][6][7] A NA variant known as familial brachial plexus neuritis (hereditary neuralgic amyotrophy [HNA]) may lead to recurrent episodes of pain, numbness, and weakness in one or both upper extremities, with episodes triggered by extreme upper extremity movements or postures, infections, immunizations, or stress.…”

Paradoxical abdominal wall movement in bilateral diaphragmatic paralysis

“…Despite this, there was no recovery, and he remained dependent on non-invasive ventilation when supine. We concluded that this was a case of bilateral isolated phrenic neuropathy 1 2…”