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Abstract

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Article in Japanese

Case Report

Bilateral phrenic nerve paralysis successfully diagnosed in a patient with neuralgic amyotrophy by examinations performed in the supine position

Yusuke Sogami  Hiroki Ohkoshi  Yuuki Hoshino  Kazuyoshi Watanabe  Hiroshi Ishihara  Kiyotaka Kugiyama 

Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine

ABSTRACT

A 69-year-old man noticed pain from his neck to his upper limbs, and two days later developed orthopnea. He was simultaneously aware of being unable to sip noodles. He was referred to our department. In addition to constrictive ventilatory impairment that worsened in the supine position, paradoxical breathing, bilateral-diaphragm immobilization observed on chest X-ray and a positive sniff test were apparent only when he was in the supine position. Therefore, we diagnosed him with bilateral phrenic nerve paralysis. His orthopnea was released by noninvasive positive pressure ventilation. Afterward, based on the preceding pain in both shoulders and a winged scapula, the original disease turned out to be neuralgic amyotrophy. In diagnosing bilateral phrenic nerve paralysis, it should be noted that the characteristic symptoms, signs and test results were apparent only in the supine position, and the inability to sip noodles may be a unique symptom in that it is manifested even in the sitting position.

KEYWORDS

Bilateral phrenic nerve paralysis  Orthopnea  Neuralgic amyotrophy 

Received 22 Oct 2018 / Accepted 21 Feb 2019

AJRS, 8(3): 220-223, 2019

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