Source: International Congress 2015 – Acute and chronic lung diseases: good clinical practice

Abstract

Neuralgic Amyotrophy (NA) or Parsonage-Turner syndrome is an idiopathic neuropathy commonly affecting the brachial plexus. Associated phrenic nerve involvement, though recognised, is thought to be very rare.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. Neurological examination of the upper limb at time of presentation was normal. Diaphragmatic fluoroscopy confirmed unilateral diaphragmatic paralysis. Magnetic resonance imaging of the neck and computed tomography of the thorax outruled cervical spinal or mediastinal pathology respectively. Pulmonary function testing demonstrated characteristic reduction in forced vital capacity between supine and sitting position (mean 56%, range 45% to 63% predicted, mean change 30.5%, range 23% to 44%), reduced maximal inspiratory pressures (mean 52.6%, range 43% to 62%), reduced sniff nasal inspiratory pressure and preserved maximal expiratory pressure. Phrenic nerve conduction studies confirmed phrenic nerve palsy.All patients were managed conservatively. Follow-up ranged from six months to three years. Symptoms and lung function variables normalised in three patients and improved significantly in the fourth.A history of ipsilateral shoulder and upper limb neuromuscular pain should be elicited and thus Neuralgic Amyotrophy considered in the differential for a unilateral diaphragmatic paralysis, even in the absence of neurological signs. Conservative management is advocated as most patients demonstrate gradual resolution over time in this case series.


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Tom McEnery (Dublin, Ireland), Thomas McEnery, Aisling McGowan, John Faul, Conor Burke, Ronan Walsh, Liam Cormican. Phrenic nerve palsy secondary to Parsonage-Turner syndrome: A case series. Eur Respir J 2015; 46: Suppl. 59, 3679

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