[An unusual cause of acute dyspnoea: neuralgic amyotrophy]

A 40-year-old man presented at the neurology outpatient clinic with sudden severe pain in both shoulders, followed by paresis of the muscles in this region. These complaints, in combination with acute dyspnoea when lying flat, and paradoxal movements of the abdomen during respiration, led to the diagnosis of neuralgic amyotrophy with phrenic nerve involvement. A 43-year-old man was seen on the pulmonary unit with severe pain in the shoulder area, followed by acute severe dyspnoea, worsening when he lay flat. Lung function analysis showed severe restriction and decreased maximal inspiratory mouth pressure. Taking into account the pain in the shoulder in combination with decreased inspiratory mouth pressure suggestive of diaphragmatic paresis, isolated neuralgic amyotrophy with phrenic nerve involvement was diagnosed. As these cases demonstrate, the diagnosis 'neuralgic amyotrophy with phrenic nerve involvement' often can be determined by history taking and physical examination. Unfamiliarity with this condition may lead to severe delay in the diagnostic process and to unnecessary investigations, especially when no accompanying paresis of the shoulder girdle and arm musculature is present.