Recurrent isolated alternating phrenic nerve palsies: a variant of brachial neuritis?

Gregory, R P; Loh, L.; Newsom‐Davis, John

doi:10.1136/thx.45.5.420

Cited by 19 publications

(14 citation statements)

References 4 publications

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“…15,22 Bilateral phrenic nerve involvement has been reported previously on just one occasion, to our knowledge, as the only component of idiopathic neuritis, with poor recovery. 10 In our patient, electrodiagnostic examination provided important information. First, it provided evidence of a neurogenic lesion, likely involving the phrenic nerve.…”

Section: Discussionmentioning

confidence: 96%

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Idiopathic bilateral diaphragmatic paralysis

Valls‐Solé

Solans

2002

Muscle and Nerve

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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.

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Section: Discussionmentioning

confidence: 96%

“…9,10,15 In the classic form of brachial plexus neuritis, 18 proximal unilateral or, more rarely, bilateral upper limb paralysis occurs following an episode of pain that usually settles in a few days. Clinical recovery is usually complete within 3 years from onset.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic bilateral diaphragmatic paralysis

Valls‐Solé

Solans

2002

Muscle and Nerve

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“…On the left the CMAP latency was slightly prolonged (9 3 ms). At follow up examinations, 12 Case 4 In September 1983 a 56 year old man was admitted for sudden dyspnoea and pain located at the cervico-dorsal junction. Chest x ray pictures showed an isolated paralysis of the LHD.…”

Section: Patients and Methods Electrophysiological Methodsmentioning

confidence: 99%

Unilateral diaphragmatic paralysis: an electrophysiological study.

Lagueny

Ellie

Saintarailles

et al. 1992

Journal of Neurology, Neurosurgery & Psychiatry

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An electrophysiological study was carried out on four patients with unilateral diaphragmatic paralysis. Whereas neurogenic involvement of the paralysed hemidiaphragm was roughly similar in all cases, neurogenic patterns could be detected in the normally moving controlateral hemidiaphragm in three cases, and the degree of involvement could be correlated with the respiratory state of the patients. EMG also showed that the neuropathic process affected the limb muscles. Thus unilateral diaphragmatic paralysis may be, at least in some cases, the localised expression of a more diffuse neuropathy, perhaps a peculiar form of neuralgic amyotrophy. Diaphragmatic paralysis has been attributed to multiple causes,"2 the most common being a tumour affecting the phrenic nerve. In some cases, however, the cause remains unknown and the paralysis is then called idiopathic.' [3][4][5] Bilateral diaphragmatic paralysis induces dyspnoea on exertion and supine position,2 whereas unilateral diaphragmatic paralysis may be asymptomatic and discovered only in routine chest x ray pictures. We carried out an electrophysiological study on four patients suffering from apparently unilateral idiopathic diaphragmatic paralysis. The paralysis was both isolated and complete on the chest x ray picture in all of the patients, although the respiratory complaints differed from case to case. Our aim was to determine whether the results of the electrophysiological tests could explain this disparity and investigate the mechanism of the paralysis. Patients and methods ELECTROPHYSIOLOGICAL METHODSThe tests were performed with MS6 (Medelec) or Viking (Nicolet) EMG apparatus. The patients were in a supine position. To record EMG a 7 cm long coaxial needle was inserted below the xiphoid appendix through the rectus abdominus and pushed along the posterior border of the stemum up to the sternal insertions of the right or left hemidiaphragm (RHD and LHD). The needle was left in place and conduction along the phrenic nerve was measured by stimulating the nerve with a surface electrode located at the lateral edge of the sternocleidomastoid. The latencies of the compound muscle action potential (CMAP) from the RHD and LHD after right and left phrenic nerve stimulation respectively, were measured and compared (normal range 6-8 ms). When the EMG showed motor unit potentials (MUPs) during deep inspiration in the paralysed HD but no CMAP after ipsilateral phrenic nerve stimulation, the controlateral phrenic nerve was stimulated to look for a possible crossed innervation. When we failed to record activity from the diaphragm with this method the coaxial needle was inserted under radioscopic control on the middle axillary line, between the seventh and eighth intercostal spaces and pushed up to the costal insertion of the diaphragm.6The CMAP after phrenic nerve stimulation was recorded as before. During these investigations no complications were observed, and coaxial needles gave information on MUPs and interference pattern that could not be obtained from surface ...

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“…In a report by Mulvey et al,all 12 patients with NA complicated by BPP were men (13), while 4 of 5 such patients were men in a report by Tsao et al (14). In other reports, NA was more frequently complicated by BPP in men than in women (15,16). There is no specific therapy for NA.…”

Section: Bpp Is a Disease That Presents With Typical Orthopnea This mentioning

confidence: 99%

“…In the case of respiratory failure due to BPP, use of non-invasive positive pressure ventilation (NPPV) assists ventilation (1,12). Regarding the prognosis of NA complicated by BPP, one report noted slight bilateral improvement in diaphragmatic function during the observation period of 1 to 4 years (14), but other reports stated that few cases showed improvement (13,15 …”

Section: Bpp Is a Disease That Presents With Typical Orthopnea This mentioning

confidence: 99%