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Vol. 46. Issue 7.
Pages 390-392 (July 2010)
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Vol. 46. Issue 7.
Pages 390-392 (July 2010)
Clinical Note
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Unilateral Painful Diaphragm Paralysis as the Only Sign of Amyotrophic Neuralgia
Parálisis diafragmática unilateral dolorosa como única manifestación de la neuralgia amiotrófica
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Marina Blanco-Aparicioa,
Corresponding author
mba@mundo-r.com

Corresponding author.
, Carmen Montero-Martíneza, Dolores Couto-Fernándezb, Berta Pernasa, María Fernández-Marrubea, Héctor Verea-Hernandoa
a Servicio de Neumología, Complejo Hospitalario Universitario, A Coruña, Spain
b Servicio de Neurología, Complejo Hospitalario Universitario, A Coruña, Spain
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Abstract

Amyotrophic neuralgia is an inflammatory and idiopathic neuropathy characterised by neuropathic pain. It was first described in 1948 as an affectation of just the brachial plexus and was called Parsonage-Turner syndrome. Although this syndrome is more frequent in the brachial plexus, it may affect concomitantly or in isolation the phrenic nerve, which diagnosis is particularly difficult without high clinical suspicion.

We present a patient with amyotrophic neuralgia whose only manifestation was left phrenic nerve involvement, and we highlight the resistance of the pain to analgesics, as well as the persistence of the symptoms and diaphragm problems for more than six months.

Keywords:
Neuropathy
Amyotrophic neuralgia
Diaphragmatic paralysis
Phrenic nerve
Resumen

La neuralgia amiotrófica es una neuropatía inflamatoria e idiopática que se caracteriza por dolor neuropático. Se describió por primera vez en 1948 como una afectación sólo del plexo braquial y se denominó síndrome de Parsonage-Turner. Aunque este síndrome es más frecuente en el plexo braquial, puede afectar de forma concomitante o aislada al nervio frénico, y en esta circunstancia el diagnóstico es muy difícil si no hay alta sospecha clínica.

Presentamos el caso de un paciente con neuralgia amiotrófica cuya única manifestación fue la afectación frénica izquierda, y destacamos la refractariedad del dolor a los analgésicos, así como la persistencia de los síntomas y de la alteración diafragmática durante más de 6 meses.

Palabras clave:
Neuropatía
Neuralgia amiotrófica
Parálisis diafragmática
Nervio frénico
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References
[1.]
G.J. Gibson.
Diaphragmatic paresis: pathophysiology, clinical features, and investigation.
Thorax, 44 (1989), pp. 960-970
[2.]
J.A. Carretero Gracia, R. Álvarez Alegret, J.C. Peñalver Cuesta.
Chronic sclerosing mediastinitis: infrequent cause of unilateral diaphragmatic paralysis.
Arch Bronconeumol, 36 (2000), pp. 417-419
[3.]
A. Lagueny, E. Ellie, J. Saintarailles, R. Marthan, M. Barat, J. Julien.
Unilateral diaphragmatic paralysis: an electrophysiological study.
J Neurol Neurosurg Psychiatry, 55 (1992), pp. 316-318
[4.]
M.J. Parsonage, J.W. Turner.
Neuralgia amyotrophy, the shoulder girdle syndrome.
Lancet, (1948), pp. 973-978
[5.]
H. Lahrmann, W. Grisold, F.J. Authier, U.A. Zifko.
Neuralgic amyotrophy with phrenic nerve involvement.
Muscle Nerve, 22 (1999), pp. 437-442
[6.]
P. Tsairis, P.J. Dyck, D.W. Mulder.
Natural history of brachial plexus neuropathy.
Arch Neurol, 27 (1972), pp. 109-117
[7.]
R.P. Gregory, L. Loh, J. Newsom-Davis.
Recurrent isolated alternating phrenic nerve palsies: a variant of brachial neuritis.
Thorax, 45 (1990), pp. 420-421
[8.]
R. Nardone, H. Bernhart, A. Pozzera, M. Taddie, F. Tezzon.
Respiratory weakness in neuralgic amyotrophy: report of two cases with phrenic nerve involvement.
Neurol Sci, 21 (2000), pp. 177-181
[9.]
P.T. Lin, P.B. Andersson, B.J. Distad, R.J. Barohn, S.C. Cho, Y.T. So.
Bilateral isolated phrenic neuropathy causing painless bilateral diaphragmatic paralysis.
[10.]
B.E. Tsao, D.A. Ostroskiy, A.J. Wilbourn, R.W. Shields.
Phrenic neuropathy due to neuralgia amyotrophy.
[11.]
J.E. Pellegrino, T.R. Rebbeck, M.J. Brown, T.D. Bird, P.F. Chance.
Mapping of hereditary neuralgic amyotrophy (familial brachial plexus neuropathy) to distal chromosome 17Q.
Neurology, 46 (1996), pp. 1128-1132
[12.]
A. Sierra, J. Prat, J. Bas, A. Romeu, J. Montero, J.AM. Matos, et al.
Blood lymphocytes are sensitized to brachial plexus nerves in patients with neuralgic amyotrophy.
Acta Neurol Scand, 83 (1991), pp. 183-186
[13.]
J. Turner, M. Parsonage.
Neuralgic amyotrophy (paralytic brachial neuritis) with special reference to prognosis.
Lancet, 2 (1957), pp. 209-212
[14.]
C.A. Helms, S. Martínez, K.P. Speer.
Acute brachial neuritis (Parsonage-Turner syndrome): MR imaging appearance-report of three cases.
Radiology, 207 (1998), pp. 255-259
[15.]
J.D. England, A.J. Summer.
Neuralgic amyotrophy: an increasingly diverse entity.
Muscle Nerve, 10 (1987), pp. 60-68
[16.]
P.A. Pierre, C.E. Laterre, P.Y. Van den Bergh.
Neuralgia amyotrophy with involvement of cranial nerves IX, X, XI and XII.
Muscle Nerve, 13 (1990), pp. 704-707
[17.]
J.D. England.
The variations of neuralgic amyotrophy.
Muscle Nerve, 22 (1999), pp. 435-436
[18.]
J.I. Quintana González, M. Carbajo, J. Rodríguez, J. Ortiz de Saracho, G. Guzmán Davila, R. Castro Deza Sanz.
Unilateral diaphragmatic paralysis treated successfully by plication.
Arch Bronconeumol, 37 (2001), pp. 401-403
[19.]
M. Kalluri, J.T. Huggins, C. Strange.
A 56-year-old woman with arm pain, dyspnea, and an elevated diaphragm.
Chest, 133 (2008), pp. 296-299
[20.]
D. Mulvey, R. Aquilina, M. Elliot, J. Moxham, M. Green.
Diaphragmatic dysfunction in neuralgic amyotrophy: an electrophysiologic evaluation of 16 patients presenting with dyspnea.
Am Rev Respir Dis, 147 (1993), pp. 66-71
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