Bilateral Phrenic Nerve Palsy Associated With Neuralgic Amyotrophy

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 May 13

PMID 38738025

Authors

Wataru Shiraishi

Yuichi Murata

Yukiko Inamori

Ayano Matsuyoshi

Yusuke Nakazawa

Affiliations

Soon will be listed here.

Abstract

Neuralgic amyotrophy (NA) is a multifocal inflammatory neuropathy accompanied by acute pain and muscle atrophy. NA commonly affects the upper extremities, but rarely affects the phrenic nerve. Here, we report a male with neck pain, orthopnea, difficulty sleeping in the supine position, and inability to slurp. His saturated oxygen level decreased from 97% to 86% in the supine position. His right shoulder showed muscle atrophy. Chest X-ray examination in the supine position and a nerve conduction study showed phrenic palsy. We diagnosed it as bilateral phrenic nerve palsy associated with NA. NA sometimes causes phrenic nerve palsy and may cause slurping difficulty.

References

Naito K, Fukushima K, Suzuki S, Kuwahara M, Morita H, Kusunoki S . Intravenous immunoglobulin (IVIg) with methylprednisolone pulse therapy for motor impairment of neuralgic amyotrophy: clinical observations in 10 cases. Intern Med. 2012; 51(12):1493-500. DOI: 10.2169/internalmedicine.51.7049. View

van Eijk J, van Alfen N, Berrevoets M, van der Wilt G, Pillen S, van Engelen B . Evaluation of prednisolone treatment in the acute phase of neuralgic amyotrophy: an observational study. J Neurol Neurosurg Psychiatry. 2009; 80(10):1120-4. DOI: 10.1136/jnnp.2008.163386. View

Ikegami G, Abe T, Akasaka K, Kouyama A, Souma R, Matsuo T . Bilateral phrenic nerve paralysis manifested by orthopnea for 6 months in a patient with neuralgic amyotrophy. Intern Med. 2009; 48(24):2123-7. DOI: 10.2169/internalmedicine.48.1266. View

van Alfen N, van Engelen B . The clinical spectrum of neuralgic amyotrophy in 246 cases. Brain. 2005; 129(Pt 2):438-50. DOI: 10.1093/brain/awh722. View

Ijspeert J, Janssen R, van Alfen N . Neuralgic amyotrophy. Curr Opin Neurol. 2021; 34(5):605-612. DOI: 10.1097/WCO.0000000000000968. View

Lahrmann H, Grisold W, Authier F, Zifko U . Neuralgic amyotrophy with phrenic nerve involvement. Muscle Nerve. 1999; 22(4):437-42. DOI: 10.1002/(sici)1097-4598(199904)22:4<437::aid-mus2>3.0.co;2-f. View

Herbert A, Khan W, Madi S . A case of progressive orthopnoea and shoulder pain secondary to bilateral diaphragmatic paralysis. BMJ Case Rep. 2017; 2017. PMC: 5534823. DOI: 10.1136/bcr-2017-219892. View

Moriguchi K, Miyamoto K, Takada K, Kusunoki S . Four cases of anti-ganglioside antibody-positive neuralgic amyotrophy with good response to intravenous immunoglobulin infusion therapy. J Neuroimmunol. 2011; 238(1-2):107-9. DOI: 10.1016/j.jneuroim.2011.08.005. View

Vilke G, Chan T, Neuman T, Clausen J . Spirometry in normal subjects in sitting, prone, and supine positions. Respir Care. 2000; 45(4):407-10. View

10.

van Alfen N, Doorduin J, van Rosmalen M, van Eijk J, Heijdra Y, Boon A . Phrenic neuropathy and diaphragm dysfunction in neuralgic amyotrophy. Neurology. 2018; 91(9):e843-e849. DOI: 10.1212/WNL.0000000000006076. View

11.

Holtbernd F, Am Zehnhoff-Dinnesen A, Duning T, Kemmling A, Ringelstein E . An unusual case of neuralgic amyotrophy presenting with bilateral phrenic nerve and vocal cord paresis. Case Rep Neurol. 2011; 3(1):69-74. PMC: 3072197. DOI: 10.1159/000325061. View

12.

Kokatnur L, Rudrappa M . Diaphragmatic Palsy. Diseases. 2018; 6(1). PMC: 5871962. DOI: 10.3390/diseases6010016. View

13.

McCool F, Mead J . Dyspnea on immersion: mechanisms in patients with bilateral diaphragm paralysis. Am Rev Respir Dis. 1989; 139(1):275-6. DOI: 10.1164/ajrccm/139.1.275. View

14.

Shinder N, POLSON A, Pringle E, ODonnell D . Neuralgic amyotrophy: A rare cause of bilateral diaphragmatic paralysis. Can Respir J. 1998; 5(2):139-42. DOI: 10.1155/1998/926375. View

15.

Gstoettner C, Mayer J, Rassam S, Hruby L, Salminger S, Sturma A . Neuralgic amyotrophy: a paradigm shift in diagnosis and treatment. J Neurol Neurosurg Psychiatry. 2020; 91(8):879-888. DOI: 10.1136/jnnp-2020-323164. View

16.

Calvo E, Brugarolas A . Cervical phrenic nerve block for intractable hiccups in cancer patients. J Natl Cancer Inst. 2002; 94(15):1175-6. DOI: 10.1093/jnci/94.15.1175. View

17.

Parsonage M, TURNER J . Neuralgic amyotrophy; the shoulder-girdle syndrome. Lancet. 1948; 1(6513):973-8. DOI: 10.1016/s0140-6736(48)90611-4. View

18.

Laghi F, Tobin M . Disorders of the respiratory muscles. Am J Respir Crit Care Med. 2003; 168(1):10-48. DOI: 10.1164/rccm.2206020. View

19.

Ricoy J, Rodriguez-Nunez N, Alvarez-Dobano J, Toubes M, Riveiro V, Valdes L . Diaphragmatic dysfunction. Pulmonology. 2018; 25(4):223-235. DOI: 10.1016/j.pulmoe.2018.10.008. View