Bilateral Phrenic Nerve Lesion Manifesting as an Orthopnea – Three Case Reports


Authors: E. Ehler 1;  J. Latta 1;  P. Vojtíšek 2;  M. Mrklovský 3
Authors‘ workplace: Pardubická krajská nemocnice, a. s. Neurologická klinika FZS UPa 1;  Pardubická krajská nemocnice, a. s. Kardiologické oddělení, Interní klinika FZS UPa 2;  Pardubická krajská nemocnice, a. s. Radiodiagnostické oddělení 3
Published in: Cesk Slov Neurol N 2012; 75/108(3): 368-372
Category: Case Report

Overview

Orthopnea is a severe dyspnea occurring at supine position. In addition to internal and pulmonary etiology, orthopnea occurs in patients with respiratory muscle weakness. Acute onset of orthopnea on the basis of bilateral phrenic nerve lesion is the most frequently seen in patients with neuralgic amyotrophy. Clinically, there is paradoxical breathing with prominent worsening after lying down, so that the patient is urged to immediately sit down. Chest radiography and chest sonography, are the most important auxiliary examinations, followed by motor nerve conduction studies of phrenic nerves and needle electromyography of diaphragm. The authors describe case reports of three patients with severe bilateral phrenic nerve lesions on the basis of neuralgic amyotrophy.

Key words:
orthopnea – spirometry – phrenic nerve – electromyography – neuralgic amyotrophy


Sources

1. Qureshi A. Diaphragm paralysis. Sem Resp Crit Care Med 2009; 30(3): 315–320.

2. Laghi F, Tobin MJ. Disorders of the respiratory muscles. Am J Resp Crit Care Med 2003; 168(1): 10–48.

3. Otto CM: Textbook of Clinical Echocardiography. 2nd ed. Philadelphia: WB Saunders Co. 2000.

4. Amato AA, Russell JA. Neuromuscular disorders. New York: McGraw Hill 2008.

5. Kumar N, Folger WN, Bolton CF. Dyspnea as the predominant manifestation of bilateral phrenic neuropathy. Mayo Clin Proc 2004; 79(12): 1563–1565.

6. Van Alfen N. The neuralgic amyotrophy consultation. J Neurol 2007; 254(6): 695–704.

7. Stewart JD. Focal peripheral neuropathies. 3rd ed. Philadelphia: Lippincott Williams Wilkins 2000.

8. Perez T. Neuromuscular diseases – assessment of the respiratory muscles. Rev Neurol 2006; 162(4): 437–444.

9. Ikegami G, Abe T, Akasaka K, Kotryama A, Souma R, Mtsuo T et al. Bilateral phrenic nerve paralysis manifested by orthopnea for 6 months in a patient with neuralgic amyotrophy. Inter Med 2009; 48(24): 2123–2127.

10. Hall C. Essential biochemistry and fysiology of (NT-pro)BNP. Eur J Heart Fail 2004; 6(3): 257–260.

11. Kawaguchi Y, Kitagawa H, Nakamura H, Gejo R, Kimura T. Neurophysiological tests for respiratory function by compound muscle action poten­tials from the diaphragm. J Bone Joint Surg Br 2000; 82(5): 695–701.

12. Tsao BE, Ostrovskiy DA, Wilbourn AJ, Shields RW. Phrenic neuropathy due to neuralgic amyotrophy. Neurology 2006; 66(10): 1582–1584.

13. Crausmann RS, Summerhill EM, McCool FD. Idio­pathic diaphragmatic paralysis: Bell’s palsy of the dia­phragm? Lung 2009; 187(3): 153–157.

14. Ehler E, Ambler Z. Mononeuropatie. Praha: Galén 2002.

15. Rubin DI. Diseases of the plexus. Continuum 2008; 14(3): 156–179.

16. Petrera JE. Electrophysiologial methods and clinical facts in neuralgic amyotrophy. Methods in Clinical Neurophysiology 1993; 4(2): 29–59.

17. Van Alfen N, van Engelen BG. The clinical spectrum of neuralgic amyotrophy in 246 cases. Brain 2006; 129(2): 438–450.

18. Horáček O, Mazanec R. Bolestivé syndromy u neuralgické amyotrofie brachiálního plexu – příspěvek k diferenciální diagnostice. Rehab Fyz Lék 2007; 14(2): 39–44.

19. Pourmand R. Immune-mediated neuromuscular diseases. Basel: Karger 2009.

20. Tsairis P, Dyck PJ, Mulder DW. Natural history of brachial plexus neuropathy. Report on 99 patiens. Arch Neurol 1972; 27(2): 109–117.

21. Sathasivam S, Lecky B, Manohar R, Selvan A. Neuralgic amyotrophy. J Bone Joint Surg Br 2008; 90(5): 550–553.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2012 Issue 3

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account