Idiopathic bilateral diaphragmatic paralysis

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 airw...

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Bibliographic Details
Published in:Muscle & nerve 2002-04, Vol.25 (4), p.619-623
Main Authors: Valls‐Solé, Josep, Solans, Margarita
Format: Article
Language:English
Subjects:
Action Potentials - physiology
Adult
axonal reinnervation
Biological and medical sciences
diaphragm
Diaphragm - innervation
Diaphragm - physiopathology
Diseases of striated muscles. Neuromuscular diseases
Dyspnea - etiology
Dyspnea - pathology
Dyspnea - physiopathology
Electric Stimulation
Electromyography
Humans
idiopathic brachial neuritis
Magnetics
Male
Medical sciences
Mononeuropathies - pathology
Mononeuropathies - physiopathology
Neural Conduction - physiology
Neurology
Pain - etiology
Pain - pathology
Pain - physiopathology
Phrenic Nerve - pathology
Phrenic Nerve - physiopathology
phrenic neuropathy
Recovery of Function - physiology
Respiration, Artificial
respiratory failure
Respiratory Paralysis - etiology
Respiratory Paralysis - pathology
Respiratory Paralysis - physiopathology
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Description
Summary: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. © 2002 Wiley Periodicals, Inc. Muscle Nerve 25: 000–000, 2002.
ISSN:0148-639X
1097-4598
DOI:10.1002/mus.10079