Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: Paralyzed diaphragm My lower right lobe has been collapsed for 5 monthes now and the doctors have given me all types of tests to see what caused it. They say it is because I have a paralyzed diaghragm. I have been getting weaker, no energy, shortness of breath, hands falling asleep especially at night and my doctor has finally made an appointment for me with a neurologist. What can cause these symptoms and are there any treatments for the collapsed lobe and paralyzed diaphragm?
Dear Frederick: The two sides of the diaphragm sre supplid by the two phrenic nerves. These are long nerves that start from the upper neck (C2-4 levels), pass through the thorax on either side of the heart, and reach the diaphragm. Despite their theoretical vulnerability due to their length, their isolated involvement is quite rare. Isolated weakness of the left (but not the right) hemidiaphragm is relatively common among normal aymptomatic people. Phrenic nerve paralysis can occur from trauma to the nerve or to the cervical spinal cord, tumors in the neck or in the chest, vasculitis, and from cold trauma after cardiac surgery. Without an obvious history, however, an isolated phrenic nerve paralysis is commonly attributed to a syndrome called neuralgic amyotrophy. This syndrome in most individuals presents as an acute painful paralysis of one or more of shoulder, arm, or forearm muscles without obvious cause, but sometimes following infection, surgery or vaccination, or during pregnancy. In some cases, instead of involving a nerve of the arm, it involves the phrenic nerve. Onset is often with some shoulder pain. The problem may improve over time with nerve re-growth in some cases. In any situation, a consultation with a pulmonologist is appropriate for management of collapse with positive-pressure breaths, etc. An EMG examination may be helpful diagnostically and prognostically. | |
