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An unusual case of neuralgic amyotrophy presenting with bilateral phrenic nerve and vocal cord paresis.
[neuralgic amyotrophy]
Neuralgic
amyotrophy
(
brachial
plexus
neuropathy
,
brachial
plexus
neuritis
,
or
Parsonage-
Turner
syndrome
)
is
an
uncommon
inflammatory
condition
typically
characterized
by
acute
and
severe
shoulder
pain
followed
by
paresis
with
muscle
weakness
and
atrophy
of
the
upper
limb
or
shoulder
girdle
.
We
report
an
unusual
clinical
manifestation
of
neuralgic
amyotrophy
,
namely
bilateral
phrenic
nerve
palsy
with
concomitant
laryngeal
paresis
.
A
55
-
year
-old
male
presented
with
orthopnea
and
aphonia
after
an
episode
of
bilateral
shoulder
pain
preceded
by
an
upper
respiratory
tract
infection
.
Spirometry
,
chest
X-
ray
and
videolaryngoscopy
revealed
bilateral
and
simultaneous
paresis
of
the
diaphragm
and
the
vocal
cords
.
Clinical
examination
at
admission
and
at
the
2
-
month
follow-up
did
not
show
upper
limb
weakness
or
atrophy
,
except
for
a
mild
atrophy
of
the
right
supraspinatus
muscle
.
An
electromyography
of
the
upper
limb
muscles
and
nerve
conduction
studies
did
not
reveal
signs
of
denervation
.
Analysis
of
the
cerebrospinal
fluid
and
an
MRI
of
the
neuraxis
were
unremarkable
.
After
treatment
with
prednisolone
,
vocal
cord
function
markedly
improved
within
8
weeks
,
whereas
paresis
of
the
diaphragm
persisted
.
Shoulder
pain
followed
by
diaphragmatic
paralysis
with
dyspnea
and
hoarseness
may
be
a
manifestation
of
neuralgic
amyotrophy
even
if
upper
limb
or
shoulder
girdle
palsies
are
absent
.
Diseases
Validation
Diseases presenting
"nerve conduction studies did not reveal signs of denervation"
symptom
neuralgic amyotrophy
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