Bilateral Phrenic Nerve Paralysis Manifested by Orthopnea for 6 Months in a Patient with Neuralgic Amyotrophy

Gaku Ikegami; Tokuro Abe; Keiichi Akasaka; Akemi Kouyama; Ryosuke Souma; Takashi Matsuo; Kenya Kouyama; Hiroki Fujiwara; Toshio Ichiwata; Koshu Nagao

doi:10.2169/internalmedicine.48.1266

CASE REPORTS

Bilateral Phrenic Nerve Paralysis Manifested by Orthopnea for 6 Months in a Patient with Neuralgic Amyotrophy

Gaku Ikegami, Tokuro Abe, Keiichi Akasaka, Akemi Kouyama, Ryosuke Souma, Takashi Matsuo, Kenya Kouyama, Hiroki Fujiwara, Toshio Ichiwata, Koshu Nagao

Author information

Gaku Ikegami
Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital
Tokuro Abe
Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital
Keiichi Akasaka
Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital
Akemi Kouyama
Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital
Ryosuke Souma
Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital
Takashi Matsuo
Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital
Kenya Kouyama
Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital
Hiroki Fujiwara
Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital
Toshio Ichiwata
Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital
Koshu Nagao
Department of Respiratory Medicine, Dokkyo Medical University Koshigaya Hospital

Keywords: bilateral phrenic nerve paralysis, neuralgic amyotrophy, orthopnea, paradoxical breathing, gravity

JOURNAL OPEN ACCESS

2009 Volume 48 Issue 24 Pages 2123-2127

DOI https://doi.org/10.2169/internalmedicine.48.1266

Details

Abstract

Bilateral phrenic nerve paralysis (BPP) is a relatively rare disease manifested by slight dyspnea at rest and on exertion in the sitting and standing positions and by dyspnea in the supine position. A 67-year-old man, who was a painter presented with severe pain in both shoulder regions that had evolved into orthopnea and forced him to sleep in a sitting position at night. Dyspnea and paradoxical respiratory movement in the supine position raised suspicions of BPP. The most striking feature in this case was that the rapid onset of pain in both shoulder regions was followed by BPP. The BPP was considered to be secondary to neuralgic amyotrophy (NA).

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