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Complete hemidiaphragmatic paralysis in a patient with multiple sclerosis.
J M Balbierz1, M Ellenberg, J C Honet
1Department of Rehabilitation Medicine, Sinai Hospital, Detroit, Michigan 48235.
American Journal of Physical Medicine & Rehabilitation
|August 1, 1988
Summary
Multiple sclerosis can cause rare unilateral diaphragmatic paralysis, leading to respiratory failure. Prompt steroid treatment improved symptoms and restored diaphragm function in this unique case.
Area of Science:
- Neurology
- Pulmonology
- Radiology
Background:
- Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system.
- Diaphragmatic paralysis, though rare, can be a severe complication affecting respiratory function.
Observation:
- A patient with established multiple sclerosis presented with acute unilateral diaphragmatic paralysis.
- Symptoms included decreased vital capacity (600 mL), impending respiratory failure, increased lower extremity spasticity, and neck stiffness.
- Radiographic and fluoroscopic imaging confirmed diaphragmatic paralysis; phrenic nerve stimulation showed a normal response latency and amplitude.
Findings:
- High-dose intravenous steroids led to significant improvement in neck stiffness and spasticity.
- The patient's vital capacity increased to 1500 mL.
- Follow-up imaging demonstrated restored diaphragm position and movement.
Implications:
- This case suggests demyelinating plaques in brainstem fibers to the phrenic nucleus as a potential cause of diaphragmatic paralysis in MS.
- It highlights a rare presentation of MS involving upper motor neuron phrenic nerve paralysis.
- Early diagnosis and treatment with steroids may be crucial for managing this critical complication.