scholarly journals Recognition of phrenic paralysis as atypical presentation during CT chest examination of COVID-19 infection and its correlation with CT severity scoring: a local experience during pandemic era

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Emad H. Abdeldayem ◽  
Ahmed S. Abdelrahman ◽  
Mohamed G. Mansour
Keyword(s):  
Phrenic Nerve ◽  
Severity Score ◽  
Nerve Palsy ◽  
Diaphragmatic Paralysis ◽  
World Health ◽  
Phrenic Nerve Palsy ◽  
Chest Examination ◽  
Incidental Discovery ◽  
Pulmonary Changes

Abstract Background Coronavirus disease 2019 (COVID-19) was declared a global pandemic by the World Health Organization on March 11, 2020. COVID-19 infection is considered a multi-system disease with neurological, digestive, and cardiovascular symptoms and complications. It can trigger acute and diffuse endothelial dysfunction, resulting in a cytokine storm, most likely induced by the interleukin-6 (IL-6) amplifier. The peripheral and central neurological complications may explain some clinical manifestations such as vagus nerve palsy. The known main CT chest findings of COVID-19 pneumonia include ground glass patches, pulmonary consolidations, inter-lobar septal thickening, crazy paving appearance, and others. We presented our experience in the incidental discovery of phrenic nerve paralysis as atypical chest finding in patients with a known history of COVID-19-associated pneumonia, proved by RT-PCR and coming for evaluation of the lung changes. Patients with evidence of diaphragmatic paralysis underwent close follow-up with a re-evaluation of the phrenic nerve palsy at their routine follow-up for COVID-19 pneumonia. The association of the phrenic nerve palsy was correlated with the CT chest severity score. Results Among 1527 scanned patients with known COVID-19 pneumonia, we had recognized 23 patients (1.5%) with unilateral diaphragmatic paralysis, accidentally discovered during CT chest examination. Twenty-one patients had shown complete recovery of the associated diaphragmatic paralysis during their follow-up CT chest with regression or the near-total resolution of the pulmonary changes of COVID-19- pneumonia. No significant correlation between the incidence of unilateral diaphragmatic paralysis and CT severity score with p value = 0.28. Conclusion Phrenic paralysis is considered a serious but rare neurological complication of COVID-19 pneumonia. No significant correlation between the CT severity score and the incidental discovery of unilateral diaphragmatic paralysis. The majority of the cases show spontaneous recovery together with the improvement of the pulmonary changes of COVID-19 pneumonia. The association of phrenic paralysis with anosmia and dysgeusia could suggest a direct viral attack on the nerve cells.

117. Phrenic nerve palsy in pediatric heart surgery: The neurophysiological contribution in follow up and decision making

2016 ◽  
Vol 127 (4) ◽  
pp. e159
Author(s):  
A. Segatti ◽  
L. Alessandrini ◽  
S. Zanelli ◽  
P.A. Santuz ◽  
P. Biban ◽  
...  
Keyword(s):  
Decision Making ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Heart Surgery ◽  
Phrenic Nerve Palsy ◽  
Pediatric Heart Surgery

Neurological recovery from pentaplegia after resection for sacral plasmacytoma presenting with POEMS syndrome

2009 ◽  
Vol 10 (4) ◽  
pp. 324-328 ◽  
Author(s):  
Yoshihisa Kotani ◽  
Manabu Ito ◽  
Kuniyoshi Abumi ◽  
Keigo Yasui ◽  
Akio Minami
Keyword(s):  
Respiratory Failure ◽  
Phrenic Nerve ◽  
Tumor Recurrence ◽  
Nerve Palsy ◽  
Poems Syndrome ◽  
Neurological Recovery ◽  
Phrenic Nerve Palsy ◽  
First Report

The authors describe a case of a 52-year-old woman in whom tetraplegia developed with neurological respiratory failure due to POEMS syndrome associated with a solitary sacral plasmacytoma. Resection was finally performed after her condition proved resistant to radiation and chemotherapy. The patient showed a dramatic recovery and was ambulatory without tumor recurrence after 5 years and 6 months of follow-up. To the authors' knowledge, there are only 3 reported cases in the literature of bilateral phrenic nerve palsy leading to respiratory failure treated by chemotherapy. This is the first report describing neurological recovery after surgery for pentaplegia due to POEMS syndrome associated with solitary sacral plasmacytoma.

scholarly journals Neuromyelitis optica with unilateral diaphragmatic paralysis

2018 ◽  
pp. bcr-2018-225984
Author(s):  
Sami Bennji ◽  
Diaeddin Sagar ◽  
Naeem Brey ◽  
Coenraad Koegelenberg
Keyword(s):  
Case Report ◽  
Female Patient ◽  
Neuromyelitis Optica ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Diaphragmatic Paralysis ◽  
Left Hemiparesis ◽  
Intravenous Methylprednisolone ◽  
Phrenic Nerve Palsy

In this case report, we describe the course of a female patient who is known to have neuromyelitis optica (NMO) and developed left hemiparesis and unilateral diaphragmatic paralysis. She was initially treated with intravenous methylprednisolone 1 g daily for 5 days without improvement. Subsequently, she received five sessions of a plasmapheresis. Her hemiparesis had improved after few days. however, the phrenic nerve palsy remained.

Carotid-Axillary Bypass as an Alternative to Carotid-Subclavian Bypass Following Coverage of Left Subclavian Artery During TEVAR

2020 ◽  
pp. 153857442098365
Author(s):  
Michael H. Parker ◽  
Dayle K. Colpitts ◽  
Genevieve F. Gilson ◽  
Liam Ryan ◽  
Dipankar Mukherjee
Keyword(s):  
Subclavian Artery ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Left Subclavian Artery ◽  
Vascular Complications ◽  
Complication Rates ◽  
Nerve Injuries ◽  
Phrenic Nerve Palsy ◽  
Safe Alternative ◽  
Landing Zone

Introduction: Thoracic Endovascular Aortic Repair (TEVAR) has become the procedure of choice for pathology involving the descending thoracic aorta since its approval by the FDA in 2005. Left subclavian artery (LSA) coverage is commonly required to facilitate an adequate proximal landing zone for the endograft. The traditional revascularization procedure of choice is carotid-subclavian bypass, however recent studies report complication rates as high as 29%—specifically phrenic nerve palsy in 25% of patients undergoing this procedure. Our aim is to present our experience using carotid-axillary bypass as a safe alternative to carotid-subclavian bypass. Methods: All patients undergoing carotid-axillary bypass for TEVAR with LSA coverage between June 2016 and September 2019 at a tertiary medical center were retrospectively identified. Short-term and long-term complications were identified and analyzed including: phrenic nerve, recurrent laryngeal nerve, and axillary nerve injuries, as well as local vascular complications requiring re-intervention. All perioperative chest radiographs were reviewed for new hemidiaphragm elevation to assess for phrenic nerve injuries. Results: 35 patients underwent carotid-axillary bypass in conjunction with TEVAR during this time period. The majority of bypasses were performed concurrently with TEVAR (80.0%, 28/35) utilizing GORE PROPATEN 8 mm externally supported vascular graft (91.4%, 32/35). The complication rate specific to carotid-axillary bypass was 14.3% (5/35). We observed a significantly lower (0%, 0/35, P < 0.01) rate of phrenic nerve palsy for carotid-axillary bypass compared to the previously reported 25% (27/107) for carotid-subclavian bypass. For patients with available follow-up imaging (85.7%, 30/35), there was a 100% patency rate at time intervals ranging from 0-1066 days (IQR = 3-37.8). Conclusion: Carotid-axillary bypass can be performed as a safe alternative to carotid-subclavian bypass for LSA coverage during TEVAR involving a more superficial anatomic course of dissection. Phrenic nerve palsy, a well-described complication of the traditional carotid-subclavian bypass, was not observed in this retrospective series.

Phrenic nerve palsy: a rare complication of indwelling subclavian vein catheter

2000 ◽  
Vol 14 (3) ◽  
pp. 203-204 ◽  
Author(s):  
S. Aggarwal ◽  
P. Hari ◽  
A. Bagga ◽  
S.N. Mehta
Keyword(s):  
Phrenic Nerve ◽  
Subclavian Vein ◽  
Nerve Palsy ◽  
Rare Complication ◽  
Phrenic Nerve Palsy ◽  
Vein Catheter

Isolated Phrenic Nerve Palsy in the Newborn

PEDIATRICS ◽  
1972 ◽  
Vol 49 (3) ◽  
pp. 449-451
Author(s):  
Barry T. Smith
Keyword(s):  
Differential Diagnosis ◽  
Respiratory Distress ◽  
Newborn Infant ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Forceps Delivery ◽  
Phrenic Nerve Palsy ◽  
Newborn Period ◽  
History Of

A case of isolated phrenic nerve palsy in a newborn infant following a difficult forceps delivery is described. Treatment was supportive and complete clinical and radiological recovery occurred between the tenth and eighteenth days of life. Phrenic nerve palsy should be considered in the differential diagnosis of respiratory distress in the newborn period, especially if there is a history of traumatic delivery or if a brachial palsy is present.

scholarly journals Safety and efficacy of cryoballoon-ablation for atrial fibrillation performed at local hospitals: results of the german register on cryoballoon-ablation in local hospitals (REGIONAL)

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
J Michaelsen ◽  
U Parade ◽  
H Bauerle ◽  
K-D Winter ◽  
U Rauschenbach ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Pulmonary Veins ◽  
Hospital Death ◽  
Cryoballoon Ablation ◽  
Complication Rates ◽  
Community Hospitals ◽  
Phrenic Nerve Palsy ◽  
Safety And Efficacy

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf REGIONAL Background Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) has become an established procedure for the treatment of symptomatic paroxysmal and persistent atrial fibrillation (AF). The safety and efficacy of PVI at community hospitals with low to moderate case numbers is unknown. Aim To determine safety and efficacy of PVI using CBA performed at community hospitals with limited annual case numbers. Methods 1004 PVI performed consecutively between 01/2019 and 09/2020 at 20 community hospitals (each &lt;100 PVI using CBA/year) for symptomatic paroxysmal AF (n = 563) or persistentAF (n= 441) were included in this registry. CBA was performed considering local standards. Procedural data, efficacy and complications were determined. Results Mean number of PVI using CBA/year was 59 ± 26. Mean procedure time was 90.1 ± 31.6 min and mean fluoroscopy time was 19.2 ± 11.4 min. Isolation of all pulmonary veins could be achieved in 97.9% of patients, early termination of CBA due to phrenic nerve palsy was the most frequent reason for incomplete isolation. There was no in-hospital death. 2 patients (0.2%) suffered a clinical stroke. Pericardial effusion occurred in 6 patients (0.6%), 2 of them (0.2%) required pericardial drainage. Vascular complications occurred in 24 patients (2.4%), in 2 of these patients (0.2%) vascular surgery was required. In 48 patients (4.8 %) phrenic nerve palsy was noticed which persisted up to hospital discharge in 6 patients (0.6%). Conclusions PVI for paroxysmal or persistent AF using CBA can be performed at community hospitals with high efficacy and low complication rates despite low to moderate annual procedure numbers.

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