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Phrenic Nerve Palsy

Phrenic Nerve Paralysis


Presentation

  • The aim of the present article is to make the reader aware of such rare presentation of hydatid disease especially in endemic areas.[ncbi.nlm.nih.gov]
  • This study demonstrates a novel minimally invasive technique for treatment of phrenic nerve injuries presenting with symptomatic eventration of the diaphragm. It also presents long-term results of three patients treated with this operation.[ncbi.nlm.nih.gov]
  • We present a case series of four patients (all male, mean age 53) presenting with dyspnoea preceded by severe self-limiting upper limb and shoulder pain, with an elevated hemi-diaphragm on clinical examination and chest X-ray.[ncbi.nlm.nih.gov]
  • A seven-year-old girl had initial presentation mimicking Guillain-Barré syndrome based on electrophysiologic characteristics.[ncbi.nlm.nih.gov]
  • To present a case of a rare and serious complication of cervical spinal surgery and to investigate its cause.[ncbi.nlm.nih.gov]
Abdominal Obesity
  • We attribute this complication to significant abdominal obesity causing compromised pulmonary reserve and poor tolerance of transient hemidiaphragmatic paresis.[ncbi.nlm.nih.gov]
Recurrent Respiratory Infections
  • Both patients subsequently exhibited a dramatic improvement in dyspnea and recurrent respiratory infection. Interestingly, the late stage operated infant exhibited spontaneous recovery at 7 months with cessation of mechanical ventilation once.[ncbi.nlm.nih.gov]
Wound Infection
  • Postoperative complications included pneumonia (2), wound infection (1), pneumothorax (2), and mucous plug with pulmonary collapse (1). One patient died of cardiac failure at 16 days.[ncbi.nlm.nih.gov]
Recurrent Infection
  • Since they had intermittently exhibited dyspnea and recurrent infection, we performed video-assisted thoracoscopic surgery (VATS) plication in both cases, at an early and a late stage, respectively.[ncbi.nlm.nih.gov]
Feeding Difficulties
  • A right phrenic nerve palsy with severe respiratory and feeding difficulties throughout the patient's 2 1/2 years of survival was found at autopsy to relate to grossly complete atrophy of the muscle of the right diaphragm.[ncbi.nlm.nih.gov]
Neurologic Manifestation
  • Neurological manifestations like mononeuritis multiplex are seen commonly in patients with Churg Strauss syndrome. Cranial nerve involvement and central nervous system involvement are also reported, although infrequently.[ncbi.nlm.nih.gov]
Forgetful
  • Despite the popularity of nerve blocks, the surgeon must not forget the complications associated with regional anesthesia. This article describes a case of symptomatic phrenic nerve palsy after supraclavicular brachial plexus block in an obese man.[ncbi.nlm.nih.gov]
Cranial Nerve Involvement
  • Cranial nerve involvement and central nervous system involvement are also reported, although infrequently. Phrenic nerve involvement has not been reported so far.[ncbi.nlm.nih.gov]

Workup

  • He had a bronchoscopy, 2 SNIFF tests, full blood panel workup to rule autoimmune and other issues, a stress test (he was out of wind after only 3 minutes on the treadmill, but interestingly, his oxygen saturation levels stayed at 98%.[steadyhealth.com]
Left Pleural Effusion
  • Abstract A 65 year old female patient developed a large left pleural effusion and a sternal split dehiscence following aorto-coronary artery bypass grafting.[ncbi.nlm.nih.gov]

Treatment

  • We conclude that recently developed VATS plication is a safe and effective treatment for infants with phrenic nerve palsy, and should be considered as a surgical treatment at an early period.[ncbi.nlm.nih.gov]
  • Two patients required treatment due to prolonged respirator therapy/assisted ventilation for 4 weeks after cardiac surgery.[ncbi.nlm.nih.gov]
  • Although rare, phrenic nerve palsy may be a feature of CIDP and may be responsive to treatment with i.v.Ig or steroids.[ncbi.nlm.nih.gov]
  • Treatment with negative pressure lasted for 3-241 days (median 32) and was predominantly administered off the intensive care unit, including at home.[ncbi.nlm.nih.gov]
  • In cases of respiratory impairment early transthoracic diaphragmatic plication is an effective means of treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis is influenced by the underlying cause. Nerve function does not usually recover in cases of neoplastic involvement.[radiopaedia.org]
  • Generally, there is a less favorable prognosis for those with bilateral brachial plexus palsy than for those afflicted in just one limb. [4] Phrenic nerve injury (3 rd, 4 th, 5 th cervical nerves) with diaphragmatic paralysis must be considered when cyanosis[afrjtrauma.com]
  • Prognosis The prognosis for unilateral paralysis is good, providing there is no underlying significant pulmonary or cardiac disease. Some patients recover without medical intervention.[cedars-sinai.edu]
  • Ventilation Rocking Bed CPAP/BiPAP Ventilator Phrenic Nerve Pacing Not usually useful (due to injured phrenic nerve/ pacing beyond site of injury is usually not possible due to atrophy of nerve) Direct pacing of muscle requires excessively high thresholds Prognosis[mdnxs.com]
  • The prognosis depends on the underlying cause and its reversibility.[clinicaladvisor.com]

Etiology

  • Many contributing factors have been described but the etiology of bilateral phrenic nerve palsy following open cardiac surgery still remains unclear. Raised awareness of this condition is essential.[ncbi.nlm.nih.gov]
  • Etiology Many cases are idiopathic or thought to be post viral 8,9 .[radiopaedia.org]
  • This uncommon cause of respiratory distress of newborn may be missed easily among multiple common etiologies of respiratory distress of newborn if this entity is not kept in mind and thorough examination is not done.[afrjtrauma.com]
  • […] life-threatening respiratory distress. [1] Phrenic nerve damage may result from a stretch injury due to lateral hyperextension of the neck at birth. [2], [3], [4] This rare cause of respiratory distress of newborn may be missed easily among multiple common etiologies[jiaps.com]
  • Even when the etiology is not known, many times paralysis resolves on its own, albeit slowly over a period of months to more than a year.[emedicine.medscape.com]

Epidemiology

  • The epidemiology will therefore match that of the underlying etiology. Clearly presentation will depend on the underlying cause. In many cases of unilateral (majority of cases) phrenic nerve paralysis, patients are asymptomatic 7 .[radiopaedia.org]
Sex distribution
Age distribution

Pathophysiology

  • It is concluded that phrenic nerve palsy might be part of the pathophysiological mechanism in strangulation and hanging, and clinical investigation to exclude diaphragm paralysis in survived cases should be considered.[ncbi.nlm.nih.gov]
  • .); and the Department of Pathophysiology, University of Athens Medical School, Athens (G.E.T.). Address reprint requests to Dr.[nejm.org]

Prevention

  • BACKGROUND: Electromyography-guided phrenic nerve (PN) monitoring using a catheter positioned in a hepatic vein can aid in preventing phrenic nerve palsy (PNP) during cryoballoon ablation for atrial fibrillation.[ncbi.nlm.nih.gov]
  • Electromyography-guided PN monitoring seems safe and potentially helpful for prevention of PNP.[ncbi.nlm.nih.gov]
  • OBJECTIVES: To describe a technique-immediate balloon deflation (IBD)-for the prevention of persistent phrenic nerve palsy, provide data for its use, and describe in vitro simulations performed to investigate the effect of IBD on the atrium and pulmonary[ncbi.nlm.nih.gov]
  • Early operative treatment of the goiter may prevent this complication or limit its severity, thus avoiding permanent nerve injury.[ncbi.nlm.nih.gov]
  • PURPOSE: The purposes of this study were to determine whether predictors of phrenic nerve palsy (PNP) exist and to test whether a standardized ablation protocol may prevent PNP during cryoballoon (CB) ablation using the 28 mm CB.[ncbi.nlm.nih.gov]

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