scholarly journals Use of Noninvasive Ventilation with Volume-Assured Pressure Support in Neuralgic Amyotrophy with Bilateral Diaphragmatic Paralysis

2019 ◽  
Vol 13 (1) ◽  
pp. 45-47
Author(s):  
Montserrat Diaz-Abad ◽  
Neil Porter ◽  
Lindsay Zilliox ◽  
Nevins Todd
Keyword(s):  
Noninvasive Ventilation ◽  
Phrenic Nerve ◽  
Pressure Support ◽  
Disease Onset ◽  
Shoulder Girdle ◽  
Acute Onset ◽  
Diaphragmatic Paralysis ◽  
Brachial Plexopathy ◽  
Neuralgic Amyotrophy ◽  
Nerve Involvement

Neuralgic Amyotrophy (NA) is a rare, acute onset inflammatory brachial plexopathy that frequently presents with acute pain followed by shoulder girdle muscle weakness. Phrenic nerve involvement affecting the diaphragms occurs in 7-10% of cases. We present the case of a 52-year-old man with neuralgic amyotrophy with phrenic nerve involvement and bilateral diaphragmatic paralysis with marked respiratory symptoms and sleep hypoventilation, who was treated with non-invasive ventilation with volume assured pressure support mode. By 21 months post disease onset, the patient had experienced marked improvement in orthopnea, sleep quality and functional status. This is the first reported case of the use of this mode of noninvasive ventilation in neuralgic amyotrophy.

Physiological changes and compensatory mechanisms by the action of respiratory muscles in a porcine model of phrenic nerve injury

2021 ◽  
Author(s):  
Antonella LoMauro ◽  
Andrea Aliverti ◽  
Gaetano Perchiazzi ◽  
Peter Frykholm
Keyword(s):  
Pressure Support Ventilation ◽  
Phrenic Nerve ◽  
Pressure Support ◽  
Work Of Breathing ◽  
Respiratory Muscles ◽  
Nerve Damage ◽  
Diaphragmatic Paralysis ◽  
Spontaneous Respiration ◽  
Abdominal Muscles ◽  
Support Ventilation

Phrenic nerve damage may occur as a complication of specific surgical procedures, prolonged mechanical ventilation, or physical trauma. The consequent diaphragmatic paralysis or dysfunction can lead to major complications. To elucidate the role of the non-diaphragmatic respiratory muscles during partial or complete diaphragm paralysis induced by unilateral and bilateral phrenic nerve damage at different levels of ventilatory pressure support in an animal model. Ten pigs were instrumented, the phrenic nerve exposed from the neck and spontaneous respiration preserved at three levels of pressure support: high, low and null at baseline condition, after left phrenic nerve damage and bilateral phrenic nerve damage. Breathing pattern, thoraco-abdominal volumes and asynchrony and pressures were measured at each condition. Physiological breathing was predominantly diaphragmatic, homogeneously distributed between right and left sides. After unilateral damage, the paralyzed hemidiaphragm was passively dragged by the ipsilateral ribcage muscles and the contralateral hemidiaphragm. After bilateral damage, the drive to and the work of breathing of ribcage and abdominal muscles increased, to compensate for diaphragmatic paralysis, ensuing paradoxical thoraco-abdominal breathing. Increasing level of pressure support ventilation replaces this muscle group compensation. When the diaphragm is paralyzed (unilaterally and/or bilaterally), there is a coordinated reorganization of non-diaphragmatic respiratory muscles as compensation that might be obscured by high level of pressure support ventilation. Non-invasive thoraco-abdominal volume and asynchrony assessment could be useful in phrenic nerve injured patients to estimate the extent and type of inspiratory muscle dysfunction.

Phrenic Nerve Involvement in Neuralgic Amyotrophy (Parsonage-Turner Syndrome)

2020 ◽  
Vol 15 (4) ◽  
pp. 539-543
Author(s):  
Ellen Farr ◽  
Dom D’Andrea ◽  
Colin K. Franz
Keyword(s):  
Turner Syndrome ◽  
Phrenic Nerve ◽  
Neuralgic Amyotrophy ◽  
Nerve Involvement

scholarly journals Bilateral diaphragmatic paralysis after kidney surgery

2015 ◽  
Vol 77 (2) ◽  
Author(s):  
S. Sozzo ◽  
P. Carratù ◽  
M.F. Damiani ◽  
V.A. Falcone ◽  
A. Palumbo ◽  
...  
Keyword(s):  
Turner Syndrome ◽  
Phrenic Nerve ◽  
Diaphragmatic Paralysis ◽  
Transdiaphragmatic Pressure ◽  
Neuralgic Amyotrophy ◽  
X Ray ◽  
Post Surgery ◽  
Diaphragm Paralysis ◽  
Chest X Ray ◽  
Kidney Angiomyolipoma

A 57-year-old woman underwent an enucleoresection of her right kidney angiomyolipoma. Two weeks later she was admitted to our hospital because of dyspnea at rest with orthopnea. The chest x-ray showed the elevation of both hemidiaphragms and the measurement of the sniff transdiaphragmatic pressure confirmed the diagnosis of bilateral diaphragmatic paralysis. A diaphragm paralysis can be ascribed to several causes, i.e. trauma, compressive events, inflammations, neuropathies, or it can be idiopathic. In this case, it was very likely that the patient suffered from post-surgery neuralgic amyotrophy. To our knowledge, there are only a few reported cases of neuralgic amyotrophy, also known as Parsonage- Turner Syndrome, which affects only the phrenic nerve as a consequence of a surgery in an anatomically distant site.

Recurrent neuralgic amyotrophy with vagus and phrenic nerve involvement

1985 ◽  
Vol 87 (1) ◽  
pp. 39-40 ◽  
Author(s):  
W.W. Dinsmore ◽  
A.K. Irvine ◽  
M.E. Callender
Keyword(s):  
Phrenic Nerve ◽  
Neuralgic Amyotrophy ◽  
Nerve Involvement

Orthopnea From Neuralgic Amyotrophy With Bilateral Phrenic Nerve Involvement

CHEST Journal ◽  
2017 ◽  
Vol 152 (4) ◽  
pp. A892 ◽  
Author(s):  
Jeffrey Woods ◽  
Robert Walter ◽  
Edward McCann ◽  
John Sladky ◽  
Michael Morris
Keyword(s):  
Phrenic Nerve ◽  
Neuralgic Amyotrophy ◽  
Nerve Involvement

Case 16

2018 ◽  
Author(s):  
Bashar Katirji
Keyword(s):  
Phrenic Nerve ◽  
Cervical Radiculopathy ◽  
Axillary Nerve ◽  
Brachial Plexopathy ◽  
Long Thoracic Nerve ◽  
Motor Branch ◽  
Neuralgic Amyotrophy ◽  
Needle Electromyography ◽  
Brachial Neuritis ◽  
Anterior Interosseous Nerve

Neuralgic amyotrophy is a relatively uncommon disorder but important to recognize since it may be confused with brachial plexopathy, cervical radiculopathy and entrapment/compressive mononeuropathies of the upper extremity. Neuralgic amyotrophy is also known as acute brachial neuritis, acute brachial plexitis, and Parsonage-Turner syndrome. This case highlights the variable clinical and electrodiagnostic findings encountered in patients with neuralgic amyotrophy, with special attention to the most common mononeuropathies affected in this disorder. This include the long thoracic nerve, axillary nerve, phrenic nerve and anterior interosseous nerve. The peculiar needle electromyography findings associated with neuralgic amyotrophy, including selective motor branch involvement, are also discussed.

Respiratory weakness in neuralgic amyotrophy: report of two cases with phrenic nerve involvement

2000 ◽  
Vol 21 (3) ◽  
pp. 177-181 ◽  
Author(s):  
R. Nardone ◽  
H. Bernhart ◽  
A. Pozzera ◽  
M. Taddei ◽  
F. Tezzon
Keyword(s):  
Phrenic Nerve ◽  
Neuralgic Amyotrophy ◽  
Nerve Involvement

Neuralgic amyotrophy with phrenic nerve involvement

1999 ◽  
Vol 22 (4) ◽  
pp. 437-442 ◽  
Author(s):  
Heinz Lahrmann ◽  
Wolfgang Grisold ◽  
F. J�r�me Authier ◽  
Udo A. Zifko
Keyword(s):  
Phrenic Nerve ◽  
Neuralgic Amyotrophy ◽  
Nerve Involvement

scholarly journals Systemic lupus erythaematosus in a multiethnic US cohort (LUMINA) LIII: disease expression and outcome in acute onset lupus

2007 ◽  
Vol 67 (4) ◽  
pp. 500-504 ◽  
Author(s):  
A M Bertoli ◽  
L M Vilá ◽  
J D Reveille ◽  
G S Alarcón ◽  
Keyword(s):  
Disease Activity ◽  
Renal Involvement ◽  
Multivariable Analysis ◽  
Disease Onset ◽  
Clinical Manifestations ◽  
Acute Onset ◽  
Acute Disease ◽  
Stepwise Logistic Regression ◽  
Systemic Lupus ◽  
Damage Accrual

Objective:To determine the features associated with acute onset systemic lupus erythaematosus (SLE).Methods:A total of 631 SLE patients from LUMINA (for “lupus in minority populations: nature vs nurture”), a multiethnic (Hispanics, African–Americans and Caucasians) cohort, were studied. Acute disease onset was defined as the accrual of ⩾4 American College of Rheumatology (ACR) criteria for the classification of SLE in ⩽4 weeks. Socioeconomic demographic features, clinical manifestations, disease activity, damage accrual, mortality, autoantibodies, HLA class II and FCGR alleles, behavioural/psychological variables were compared between patients with acute and insidious disease onset by univariable (χ2 and Student t test) and multivariable (stepwise logistic regression) analyses.Results:A total of 94 (15%) patients had acute disease onset. In the multivariable analysis, patients with acute onset lupus had more renal involvement (odds ratio (OR) = 1.845, 95% CI 1.076–3.162; p = 0.026) and higher disease activity (OR = 1.057, 95% CI 1.005–1.112; p = 0.030). By contrast, age (OR = 0.976, 95% CI 0.956–0.997; p = 0.025), education (OR = 0.901, 95% CI 0.827–0.983, p = 0.019), health insurance (OR = 0.423, 95% CI 0.249–0.718; p = 0.001) and skin involvement (OR = 0.346, 95% CI 0.142–0.843; p = 0.019) were negatively associated with acute onset lupus. No differences were found regarding the serological, genetic and behavioural/psychological features; this was also the case for damage accrual and mortality.Conclusions:Patients with acute onset lupus seem to be younger, have a lower socio-economic status and display more severe disease in terms of clinical manifestations and disease activity. However, intermediate (damage) and long-term (mortality) outcomes appear not to be influenced by the type of disease onset in SLE.

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