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


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


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Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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