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An unusual case of orthopnea

Michael D O'brien
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DOI: https://doi.org/10.7861/clinmedicine.17-5-480
Clin Med October 2017
Michael D O'brien
Roles: Retired consultant neurologist
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Editor – Keelan et al1 describe an interesting patient with bilateral phrenic nerve palsies, which they ascribe to cervical spondylosis. The phrenic nerve arises mostly from C4 with contributions from C3 and C5. It would be quite exceptional, if not anatomically impossible, for cervical spondylosis to affect only those fascicles destined for the phrenic nerves, without any clinical evidence of a myelopathy or other radicular signs. They cite eight reported cases, seven of which had a myelopathy and one that was unilateral. A much more likely diagnosis is neuralgic amyotrophy, which may be bilateral in up to 30% of patients2 and may follow strenuous exercise (17%2), as in this patient who was lifting heavy iron tables the day before the onset of symptoms. Phrenic nerve palsy, both unilateral and bilateral is well described in neuralgic amyotrophy and maybe the presenting and only feature.3–7

Conflicts of interest

The author has no conflicts of interest to declare.

  • © Royal College of Physicians 2017. All rights reserved.

References

  1. ↵
    1. Keelan E
    , Kidney J, Judge EP. An unusual case of orthopnea. Clin Med 2017;17:245–7.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. van Alfen N
    , van Engelen BGM. The clinical spectrum of neuralgic amyotrophy in 246 cases. Brain 2006;129:438–50.
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    1. Tsairis P
    , Dyck PJ, Mulder DW. Natural history of brachial plexus neuropathy: report on 99 patients. Arch Neurol 1972;27:109–17.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Holtbernd F
    , am Zehnhoff-Dinnesen A, Duning T, et al. An unusual case of neuralgic amyotrophy presenting with bilateral phrenic nerve and vocal cord paresis. Case Rep Neurol 2011;3:69–74.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Odell JA
    , Kennelly K, Stauffer J. Phrenic nerve palsy and ­Parsonage-Turner syndrome. Ann Thoracic Surg 2011;92:349–51.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Nardone R
    , Bernhart H, Pozzera A, et al. Respiratory weakness in neuralgic amyotrophy: report of two cases with phrenic nerve involvement. Neurol Sci 2000;21:177–81.
    OpenUrlPubMed
  7. ↵
    1. Sathasivam S
    , Lecky B, Manohar R, Selvan A. Neuralgic ­amyotrophy. J Bone Joint Surg 2008;90:550–3.
    OpenUrl
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An unusual case of orthopnea
Michael D O'brien
Clinical Medicine Oct 2017, 17 (5) 480; DOI: 10.7861/clinmedicine.17-5-480

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An unusual case of orthopnea
Michael D O'brien
Clinical Medicine Oct 2017, 17 (5) 480; DOI: 10.7861/clinmedicine.17-5-480
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