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Viatgé T, Noel-Savina E, Prévot G, Faviez G, Plat G, De Boissezon X, Cintas P, Didier A. [Parsonage-Turner syndrome following severe SARS-CoV-2 infection]. Rev Mal Respir 2021; 38:853-858. [PMID: 34325956 PMCID: PMC8233958 DOI: 10.1016/j.rmr.2021.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/01/2021] [Indexed: 01/08/2023]
Abstract
Introduction Les complications de l’infection par le SARS-CoV-2 peuvent affecter la sphère neurologique ; il s’agit habituellement de cas de polyradiculonévrite aiguë inflammatoire ou de plexite. Observation Le cas clinique rapporté concerne un patient de 20 ans sans comorbidités, atteint d’une infection sévère à la COVID-19 compliquée d’un syndrome de détresse respiratoire aiguë, avec manifestations thromboemboliques et surinfection bactérienne. Ce patient souffrait également d’un trouble neurologique non spécifique lié au SARS-Cov-2 avec une paralysie pseudobulbaire (IRM, EMG et ponction lombaire étaient normaux), associé à des troubles neurologiques persistants 4 mois plus tard, caractérisés par un déficit à prédominance motrice de l’épaule gauche et une insuffisance respiratoire. Le bilan respiratoire et neurologique conclut à un syndrome de Parsonage-Turner, ou amyotrophie névralgique, affectant les racines nerveuses en C5-C6, le nerf pectoral latéral et le nerf phrénique à l’origine de l’amyotrophie de la ceinture scapulaire et de la paralysie du diaphragme gauche. Conclusion Ce cas montre que la dyspnée persistante après une infection à la COVID-19 doit faire rechercher une cause diaphragmatique et que celle-ci n’est pas toujours secondaire à la neuropathie de réanimation, mais peut aussi être le témoin d’une amyotrophie névralgique.
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Affiliation(s)
- T Viatgé
- Service de pneumologie, hôpital Larrey, CHU de Toulouse, 31059 Toulouse cedex 9, France.
| | - E Noel-Savina
- Service de pneumologie, hôpital Larrey, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - G Prévot
- Service de pneumologie, hôpital Larrey, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - G Faviez
- Service de pneumologie, hôpital Larrey, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - G Plat
- Service de pneumologie, hôpital Larrey, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - X De Boissezon
- Service de médecine physique et de réadaptation, hôpital Rangueil, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - P Cintas
- Service de neurologie, hôpital Purpan, CHU de Toulouse, 31059 Toulouse cedex 9, France
| | - A Didier
- Service de pneumologie, hôpital Larrey, CHU de Toulouse, 31059 Toulouse cedex 9, France
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Bon C, Krim E, Colin G, Picard W, Gaborieau V, Gourcerol D, Raherison C. [Bilateral diaphragmatic palsy due to Lyme neuroborreliosis]. Rev Mal Respir 2019; 36:197-203. [PMID: 30711345 DOI: 10.1016/j.rmr.2018.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/19/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Lyme disease is not uncommon and can sometimes progress to neurological complications. We report here an unusual case of bilateral diaphragmatic paralysis secondary to Lyme neuroborreliosis. CASE REPORT A 79-year-old man was admitted to the intensive care unit for acute respiratory distress requiring intubation and the long-term use of nocturnal non-invasive ventilation. Three months beforehand he had been bitten by a tick and developed erythema migrans which was treated with Doxycycline for 10 days. This clinical presentation became complicated a few days later by the progressive onset of severe dyspnoea. At admission, chest radiography revealed bilateral elevation of the diaphragm. Pulmonary function tests revealed a severe restrictive disorder aggravated by decubitus. A diaphragmatic electromyogram showed bilateral axonal polyneuropathy of the phrenic nerves. IgG and IgM antibodies to Borrelia burgdorferi were detectable in serum and cerebrospinal fluid, leading to the diagnosis of Lyme disease. He was treated with intravenous ceftriaxone 2g per day for 21 days, leading to a substantial improvement in symptoms. CONCLUSION In the presence of unilateral or bilateral diaphragmatic paralysis of undetermined aetiology, it seems relevant to perform Lyme serology in the blood and, in positive cases, to follow up with a lumbar puncture in order to detect intrathecal IgG synthesis.
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Affiliation(s)
- C Bon
- Service des maladies respiratoires, hôpital Haut-Lévêque, centre hospitalier universitaire de Bordeaux, 33600 Pessac, France.
| | - E Krim
- Service de neurologie, hôpital F. Mitterrand, 4, boulevard Hauterive, 64046 Pau, France
| | - G Colin
- Service de pneumologie, hôpital F. Mitterrand, 4, boulevard Hauterive, 64046 Pau, France
| | - W Picard
- Service de réanimation, hôpital F. Mitterrand, 4, boulevard Hauterive, 64046 Pau, France
| | - V Gaborieau
- Service de médecine interne et maladies infectieuses, hôpital F. Mitterrand, 4, boulevard Hauterive, 64046 Pau, France
| | - D Gourcerol
- Service de pneumologie, hôpital F. Mitterrand, 4, boulevard Hauterive, 64046 Pau, France
| | - C Raherison
- Service des maladies respiratoires, hôpital Haut-Lévêque, centre hospitalier universitaire de Bordeaux, 33600 Pessac, France
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Tissier-Ducamp D, Martinez S, Alagha K, Charpin D, Chanez P, Palot A. [Bilateral diaphragmatic paralysis due to Parsonage-Turner syndrome]. Rev Mal Respir 2014; 32:742-6. [PMID: 25534571 DOI: 10.1016/j.rmr.2014.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 11/11/2014] [Indexed: 11/24/2022]
Abstract
We report the case of a 49-years-old patient who presented to the accident and emergency department with sudden onset dyspnea associated with acute shoulder pain. He was breathless at rest with supine hypoxemia. He had an amyotrophic left shoulder with localized paresis of the shoulder. Both hemi-diaphragms were elevated on chest X-rays. Pulmonary function tests showed a restrictive pattern and both phrenic nerve conduction velocities were decreased. At night, alveolar hypoventilation was evidenced by elevated mean capnography (PtcCO2: 57mmHg). Neuralgic amyotrophy, Parsonage-Turner syndrome was the final diagnosis. This syndrome is a brachial plexus neuritis with a predilection for the suprascapular and axillary nerves. Phrenic nerve involvement is rare but where present can be the most prominent clinical feature as in our case report.
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Affiliation(s)
- D Tissier-Ducamp
- Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France.
| | - S Martinez
- Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France
| | - K Alagha
- Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France
| | - D Charpin
- Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France
| | - P Chanez
- Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France
| | - A Palot
- Clinique des bronches, allergies et du sommeil, Aix Marseille université, AP-HM, 13000 Marseille, France
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Le Pimpec-Barthes F, Pricopi C, Mordant P, Arame A, Badia A, Grand B, Bagan P, Hernigou A, Riquet M. [Diaphragmatic palsy and dysfunction: from physiology to surgery]. Rev Pneumol Clin 2014; 70:95-107. [PMID: 24566026 DOI: 10.1016/j.pneumo.2013.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 06/03/2023]
Abstract
The clinical presentations of diaphragm dysfunctions vary according to etiologies and unilateral or bilateral diseases. Elevation of the hemidiaphragm from peripheral origins, the most frequent situation, requires a surgical treatment only in case of major functional impact. Complete morphological and functional analyses of the neuromuscular chain and respiratory tests allow the best selection of patients to be operated. The surgical procedure may be proposed only when the diaphragm dysfunction is permanent and irreversible. Diaphragm plication for eventration through a short lateral thoracotomy, or sometimes by videothoracoscopy, is the only procedure for retensioning the hemidiaphragm. This leads to a decompression of intrathoracic organs and a repositioning of abdominal organs without effect on the hemidiaphragm active contraction. Morbidity and mortality rates after diaphragm plication are very low, more due to the patient's general condition than to surgery itself. Functional improvements after retensioning for most patients with excellent long-term results validate this procedure for symptomatic patients. In case of bilateral diseases, very few bilateral diaphragm plications have been reported. Some patients with diaphragm paralyses from central origins become permanently dependent on mechanical ventilation whereas their lungs, muscles and nerves are intact. In patients selected by rigorous neuromuscular tests, a phrenic pacing may be proposed to wean them from respirator. Two main indications have been validated: high-level tetraplegia above C3 and congenital alveolar hypoventilation from central origin. After progressive reconditioning of the diaphragm muscles following phrenic pacing at thoracic level, more than 90% of patients can be weaned from respirator within a few weeks. This weaning improves the quality of life with more physiological breathing, restored olfaction, better sleep and better speech. The positive impact of diaphragm stimulation has also been evaluated in other degenerative neurological diseases, particularly the amyotrophic lateral sclerosis. For either central or peripheral diaphragm dysfunctions, a successful surgical treatment lies on a strict preoperative selection of patients.
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Affiliation(s)
- F Le Pimpec-Barthes
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France.
| | - C Pricopi
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - P Mordant
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - A Arame
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - A Badia
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - B Grand
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - P Bagan
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - A Hernigou
- Service de radiologie, hôpital européen Georges-Pompidou, université Paris-Descartes, 75908 Paris cedex 15, France
| | - M Riquet
- Service de chirurgie thoracique oncologique et générale, transplantation pulmonaire, hôpital européen Georges-Pompidou, université Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
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