Diaphragmatic paralysis without bulbar or limb paralysis in multiple sclerosis

Area of Science:

• Neurology
• Pulmonology
• Spinal Cord Medicine

Background:

• Multiple Sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
• MS typically causes neurological deficits such as limb weakness, sensory disturbances, and visual problems.
• Respiratory complications in MS are often associated with bulbar or high cervical spinal cord involvement.

Observation:

• A patient with a long-standing history of MS presented with severe, disabling pulmonary symptoms.
• Clinical evaluation and fluoroscopy confirmed bilateral diaphragmatic paralysis.
• Magnetic resonance imaging (MRI) showed cervical spinal cord atrophy and extensive white matter lesions.

Findings:

• The patient experienced significant respiratory compromise solely due to cervical spinal cord MS.
• This presentation was unique as it occurred without concurrent bulbar dysfunction or profound limb paresis.
• The diaphragmatic paralysis was directly linked to the cervical white matter changes observed on MRI.

Implications:

• This case expands the understanding of potential respiratory complications in MS.
• It suggests that isolated cervical cord MS can lead to severe respiratory failure.
• Highlights the importance of considering diaphragmatic function in MS patients with pulmonary complaints.