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J Korean Assoc EMG Electrodiagn Med 2016;18(1):37-42.
Published online June 30, 2016.
Unilateral Phrenic Nerve Palsy in a Patient with Traumatic Brachial Plexus Injury Contributing to Early Pulmonary Complications -A Case Report-
Received: 15 May 2016   • Revised: 9 June 2016   • Accepted: 9 June 2016
Abstract
Phrenic nerve palsy (PNP) has previously been associated with brachial plexus injury (BPI) with root avulsion. PNP could lead from asymptomatic dyspnea to respiratory failure by diaphragmatic paralysis. Unilateral PNP accompanying BPI is prone to underestimation because of its asymptomatic nature contrary to bilateral PNP which results in critical clinical course such as marked dyspnea or respiratory failure. But sometimes, unilateral PNP could be one of unrecognized causes of dyspnea, exercise intolerance and even respiratory failure. We hereby report a case of bilateral BPIs with unilateral PNP, who suffered from early respiratory complications that was eventually managed by comprehensive pulmonary rehabilitation. We could detect unilateral PNP earlier owing to phrenic NCSs, EMG and ultrasonographic evaluations. And early diagnosis of unilateral PNP led to start early intervention resulting in successful ventilator weaning without complications. In this case, we suggest early consideration of evaluation for phrenic nerve injury in setting of acute traumatic BPI in facing dyspnea in trauma patient. To our knowledge, this is the first report in Asia where clinical significance of unilateral PNP is described in a patient with traumatic BPI.
Key Words: phrenic nerve, brachial plexus neuropathies, diaphragm


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