Phrenic nerve palsy associated with birth trauma – Case reports and a literature review
| Autor: | Tadashi Shiohama, Hiromi Mizuochi, Masaharu Hayashi, Maiko Suyama, Hideki Uchikawa, Yoichi Kohno, Katsunori Fujii, Hideo Yoshida, Shigetoshi Yoshida, Tomoro Hishiki |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Birth trauma medicine.medical_treatment Developmental Neuroscience Birth Injuries medicine Humans Paralysis Phrenic nerve Mechanical ventilation business.industry Infant Peripheral Nervous System Diseases Respiratory infection General Medicine musculoskeletal system medicine.disease Respiratory Paralysis Muscle atrophy Cardiac surgery Surgery Diaphragm (structural system) Phrenic Nerve Anesthesia Pediatrics Perinatology and Child Health Video-assisted thoracoscopic surgery Female Neurology (clinical) medicine.symptom business |
| Zdroj: | Brain and Development. 35:363-366 |
| ISSN: | 0387-7604 |
| Popis: | Phrenic nerve palsy is a peripheral nerve disorder caused by excessive cervical extension due to birth trauma or cardiac surgery. We describe two new patients with phrenic nerve palsy associated with birth trauma. Both patients exhibited profound dyspnea and general hypotonia immediately after birth. A chest roentgenogram and fluoroscopy revealed elevation of the diaphragm, leading to a diagnosis of phrenic nerve palsy associated with birth trauma. Since they had intermittently exhibited dyspnea and recurrent infection, we performed video-assisted thoracoscopic surgery (VATS) plication in both cases, at an early and a late stage, respectively. Both patients subsequently exhibited a dramatic improvement in dyspnea and recurrent respiratory infection. Interestingly, the late stage operated infant exhibited spontaneous recovery at 7 months with cessation of mechanical ventilation once. However, this recovery was transient and subsequently led to an increased ventilation volume demand, finally resulting in surgical treatment at 15 months. Histological examination of the diaphragm at this time showed grouped muscle atrophy caused by phrenic nerve degeneration. To our knowledge, this is the first pathologically proven report of grouped muscle atrophy of the diaphragm due to phrenic nerve degeneration, suggesting that partial impairment of phrenic nerves resulted in respiratory dysfunction with incomplete recovery. We conclude that recently developed VATS plication is a safe and effective treatment for infants with phrenic nerve palsy, and should be considered as a surgical treatment at an early period. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect