The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

PARSONAGE-TURNER SYNDROME AND HEMIDIAPHRAGMATIC DYSFUNCTION

Christine Perino1, Susan LaGambina1, Paul F. Nuccio1, Gerald L. Weinhouse2; 1Department of Respiratory Care, Brigham and Women’s Hospital, Boston, MA; 2Pulmonary & Critical Care Division, Brigham and Women’s Hospital, Boston, MA

Introduction: Parsonage-Turner Syndrome is a rare syndrome of unknown cause, affecting mainly the lower motor neurons of the brachial plexus. Case Summary: A 47 year old male, presents with fatigue, fever, chills, a dry non-productive cough, dyspnea on exertion (DOE) and left shoulder pain/weakness. A CXR is taken which read: left lower lobe pneumonia with minimal atelectasis. Despite treatment, all symptoms remained. Breath sounds were diminished over the left base. A chest CT showed an elevated left diaphragm. The patient is a chemistry teacher. He conducts laboratory research with minimal chemical exposures. He is a non-smoker. The patient stated he has slight DOE for some time, attributed to weight gain. He also experienced a “sensation” in his left arm when lifting. He suffered from pneumonia’s as a child. The patient also complained of excessive daytime sleepiness. PFT’s revealed a restrictive defect, consistent with diaphragmatic paralysis. No response to bronchodilator therapy and a significant decrease in Vital Capacity and FEV1 while supine. A Sniff Study revealed paradoxical movement of the left hemi-diaphragm. The Exercise Study was relevant for mild cardiovascular limit to exercise based on a decrease VO2max and a decreased anaerobic threshold (AT), suggesting secondary pulmonary mechanical limit. A sleep study showed disordered breathing during REM sleep- mild severity of apnea hypopnea index, with desaturations to 81% (average SpO2 of 94% throughout study). A follow up sleep study with BiPAP of 10/6cmH2O showed a positive response. His neurology exam showed evidence of a left brachial plexus lesion, affecting the phrenic nerve. An EMG revealed low amplitude left phrenic motor response. The needle EMG exam of the LUE revealed fibrillation potentials and moderate chronic changes in the infraspinatus. These abnormalities, led to a diagnosis of Parsonage-turner Syndrome. Discussion: We present a case of Parsonage-Turner syndrome which is rare, but should be considered when upper extremity weakness of unknown origin is present, especially in the setting where the patient is also showing symptoms of diaphragmatic dysfunction. Sponsored Research - None

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