Bilateral Isolated Phrenic Neuropathy: a Rare Cause of Dyspnoea

  • Carlos Couto Pulmonology Department, Garcia de Orta Hospital, Almada, Portugal
  • Pedro Pereira Neurology Department, Garcia de Orta Hospital, Almada, Portugal
  • Ana Catarina Moreira Pulmonology Department, Garcia de Orta Hospital, Almada, Portugal
  • Vicência Ribeiro Pulmonology Department, Garcia de Orta Hospital, Almada, Portugal
  • José Duarte Pulmonology Department, Garcia de Orta Hospital, Almada, Portugal

Keywords

Diaphragmatic paralysis, dyspnoea, hypoventilation, noninvasive ventilation, phrenic neuropathy

Abstract

Bilateral diaphragm paralysis due to bilateral isolated phrenic neuropathy (BIPN) is a very rare cause of unexplained respiratory failure.
We present a 65-year-old patient with no relevant previous medical history who presented in the Pulmonology Clinic with mMRC1 dyspnoea and orthopnoea. After the medical work-up, diaphragmatic paresis was diagnosed. Inspiratory muscle training resulted in mild symptomatic improvement and treatment with noninvasive mechanical ventilation (NIV) was initiated.
This condition is generally chronic and has a poorer prognosis, compared to other cases of phrenic nerve involvement. In this case, NIV restored near-normal daily function.

VIEW THE ENTIRE ARTICLE

References

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

  • Schram DJ, Vosik W, Cantral D. Diaphragmatic paralysis following cervical chiropractic manipulation: case report and review.Chest 2001;119:638–639.

  • Carratù P, Spicuzza L, Cassano A, Maniscalco M, Gadaleta F, Lacedonia D, et al. Early treatment with noninvasive positive pressure ventilation prolongs survival in amyotrophic lateral sclerosis patients with nocturnal respiratory insufficiency. Orphanet J Rare Dis 2009;4:10.

  • Petrovic M, Lahrmann H, Pohl W, Wanke T. Idiopathic diaphragmatic paralysis-satisfactory improvement of inspiratory muscle function by inspiratory muscle training. Respir Physiol Neurobiol 2009;165:266–267.

  • Kalluri M, Huggins J, Strange C. A 56-year-old woman with arm pain, dyspnea, and an elevated diaphragm. Chest 2008;133296–299.

  • Garcia G, Garcia M, Bernal M. Parálisis diafragmática bilateral idiopática tratada com ventilación mecánica no invasiva. CES Med 2016;30:85–92.

  • Lin PT, Andersson PB, Distad BJ, Barohn RJ, Cho SC, So YT, et al. Bilateral isolated phrenic neuropathy causing painless bilateral diaphragmatic paralysis. Neurology 2005;65:1499–1501.

  • Pereira MC, Mussi RF, de Carvalho Massucio RA, Camino AM, de Souza Barbeiro A, de Oliveira Villalba W, et al. Idiopathic bilateral diaphragmatic paresis. J Bras Pneumol 2006;32:481–485.

  • McCool F, Tzelepis G. Dysfunction of the diaphragm. N Engl J Med 2012;366:2036–2037.

  • Mason RJ, Broaddus VC, Murray JF, Nadel JA. Murray and Nadel's textbook of respiratory medicine. 4th ed. Philadelphia:Saunders;2005.
  • Published: 2020-01-30

    Issue: Vol 7 No 2 (view)

    Section: Articles

    How to cite:
    1.
    Couto C, Pereira P, Moreira AC, Ribeiro V, Duarte J. Bilateral Isolated Phrenic Neuropathy: a Rare Cause of Dyspnoea. EJCRIM 2020;7 doi:10.12890/2020_001258.

    Most read articles by the same author(s)