Diaphragmatic paralysis history and symptoms: Difference between revisions

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{{Diaphragmatic paralysis}}
{{Diaphragmatic paralysis}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{MA}}
==Overview==
==Overview==
The majority of patients with [disease name] are asymptomatic.
The majority of patients with unilateral diaphragmatic paralysis are asymptomatic. [[Exertional dyspnea]] and decreased exercise performance are common symtoms of unilateral diaphragmati paralysis. Less common symtoms of unilateral diaphragmatic paralysis include [[dyspnea]] at rest and [[orthopnea]]. Dyspnea in [[supine position]] and [[orthopnea]] are common symtoms of bilateral diphragmatic paralysis. Less common symtoms of bilateral diaphragmatic paralysis include daytime [[fatigue]] and [[confusion]].  
 
OR
 
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].


==History and Symptoms==
==History and Symptoms==
Patients with unilateral diaphragmatic paralysis are usually '''asymptomatic''' at rest, but may have exertional dyspnea and decreased exercise performance [9,14]. However, patients with underlying or intercurrent lung disease may experience dyspnea at rest. Orthopnea can also occur, but is not as intense as with bilateral diaphragmatic paralysis [7,15]. Unilateral diaphragm paralysis may also be associated with sleep-disordered breathing during rapid eye movement sleep [16].
Patients are asked about any history of childhood poliomyelitis, cardiac surgery (especially if the paralysis is left-sided), or chest irradiation and also pain, injury, manipulation, surgery, or irradiation of the neck or cervical spine (table 1).
If lung disease develops (eg, asthma, pneumonia, COPD, lung fibrosis), the increase in load may fatigue the already overburdened accessory muscles, leading to symptoms and signs of ventilatory failure. Respiratory insufficiency in this setting is often reversible, particularly if the lung injury is reversible (asthma attack, COPD exacerbation or pneumonia). In case of progressive lung disease, the symptoms may persist requiring long-term ventilator support. (See "Respiratory muscle weakness due to neuromuscular disease: Clinical manifestations and evaluation", section on 'Clinical manifestations'.)
*The majority of patients with [disease name] are asymptomatic.
OR
*The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
*Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. 
===History===
===History===


==== Unilateral diaphragmatic paralysis ====
==== Unilateral diaphragmatic paralysis ====
Patients with unilateral diaphragmatic paralysis may have a positive history of:<ref name="pmid6292583">{{cite journal |vauthors=Piehler JM, Pairolero PC, Gracey DR, Bernatz PE |title=Unexplained diaphragmatic paralysis: a harbinger of malignant disease? |journal=J. Thorac. Cardiovasc. Surg. |volume=84 |issue=6 |pages=861–4 |year=1982 |pmid=6292583 |doi= |url=}}</ref>
Patients with unilateral diaphragmatic paralysis may have a positive history of:<ref name="pmid6292583">{{cite journal |vauthors=Piehler JM, Pairolero PC, Gracey DR, Bernatz PE |title=Unexplained diaphragmatic paralysis: a harbinger of malignant disease? |journal=J. Thorac. Cardiovasc. Surg. |volume=84 |issue=6 |pages=861–4 |year=1982 |pmid=6292583 |doi= |url=}}</ref>
*Childhood poliomyelitis
*Childhood [[poliomyelitis]]
*Cardiac surgery in left sided paralysis
*[[Cardiac surgery]] in left sided paralysis
*Chest irridation
*Chest [[irradiation]]
*Injury  
*[[Injury]]
*Irradiation of the neck or cervical spine
*[[Irradiation]] of the [[neck]] or [[cervical spine]]


==== Bilateral diphragmatic paralysis ====
==== Bilateral diphragmatic paralysis ====
Patients with bilateral diaphragmatic paralysis may have a positive history of :
Patients with bilateral diaphragmatic paralysis may have a positive history of :
* Known neuromuscular disease
* Known [[neuromuscular disease]]


===Common Symptoms===
===Common Symptoms===
Line 38: Line 25:
==== Unilateral diaphragmatic paralysis:<ref name="pmid11991876">{{cite journal |vauthors=Hart N, Nickol AH, Cramer D, Ward SP, Lofaso F, Pride NB, Moxham J, Polkey MI |title=Effect of severe isolated unilateral and bilateral diaphragm weakness on exercise performance |journal=Am. J. Respir. Crit. Care Med. |volume=165 |issue=9 |pages=1265–70 |year=2002 |pmid=11991876 |doi=10.1164/rccm.2110016 |url=}}</ref> ====
==== Unilateral diaphragmatic paralysis:<ref name="pmid11991876">{{cite journal |vauthors=Hart N, Nickol AH, Cramer D, Ward SP, Lofaso F, Pride NB, Moxham J, Polkey MI |title=Effect of severe isolated unilateral and bilateral diaphragm weakness on exercise performance |journal=Am. J. Respir. Crit. Care Med. |volume=165 |issue=9 |pages=1265–70 |year=2002 |pmid=11991876 |doi=10.1164/rccm.2110016 |url=}}</ref> ====
Common symtoms of unilateral diaphragmatic paralysis include:  
Common symtoms of unilateral diaphragmatic paralysis include:  
*Usually asymptomatic at rest
*Usually [[asymptomatic]] at rest
*Exertional dyspnea
*[[Exertional dyspnea]]
*Decreased exercise performance  
*Decreased exercise performance  


==== Bilateral diaphragmatic paralysis ====
==== Bilateral diaphragmatic paralysis ====
* Orthopnea<ref name="pmid872664">{{cite journal |vauthors=Sandham JD, Shaw DT, Guenter CA |title=Acute supine respiratory failure due to bilateral diaphragmatic paralysis |journal=Chest |volume=72 |issue=1 |pages=96–8 |year=1977 |pmid=872664 |doi= |url=}}</ref>
* [[Orthopnea]]<ref name="pmid872664">{{cite journal |vauthors=Sandham JD, Shaw DT, Guenter CA |title=Acute supine respiratory failure due to bilateral diaphragmatic paralysis |journal=Chest |volume=72 |issue=1 |pages=96–8 |year=1977 |pmid=872664 |doi= |url=}}</ref>
* Dyspnea in supine position<ref name="pmid15595343">{{cite journal |vauthors=Kumar N, Folger WN, Bolton CF |title=Dyspnea as the predominant manifestation of bilateral phrenic neuropathy |journal=Mayo Clin. Proc. |volume=79 |issue=12 |pages=1563–5 |year=2004 |pmid=15595343 |doi=10.4065/79.12.1563 |url=}}</ref>
* [[Dyspnea]] in [[supine]] position<ref name="pmid15595343">{{cite journal |vauthors=Kumar N, Folger WN, Bolton CF |title=Dyspnea as the predominant manifestation of bilateral phrenic neuropathy |journal=Mayo Clin. Proc. |volume=79 |issue=12 |pages=1563–5 |year=2004 |pmid=15595343 |doi=10.4065/79.12.1563 |url=}}</ref>
*
===Less Common Symptoms===
===Less Common Symptoms===


==== Unilateral diaphragmatic paralysis ====
==== Unilateral diaphragmatic paralysis ====
Less common symptoms of unilateral diaphragmatic paralysis include:  
Less common symptoms of unilateral diaphragmatic paralysis include:  
*Dyspnea at rest in pateints with underlying lung disease
*[[Dyspnea]] at rest in pateints with underlying lung disease
*Orthopnea<ref name="pmid3202460">{{cite journal |vauthors=Laroche CM, Carroll N, Moxham J, Green M |title=Clinical significance of severe isolated diaphragm weakness |journal=Am. Rev. Respir. Dis. |volume=138 |issue=4 |pages=862–6 |year=1988 |pmid=3202460 |doi=10.1164/ajrccm/138.4.862 |url=}}</ref>  
*[[Orthopnea]]<ref name="pmid3202460">{{cite journal |vauthors=Laroche CM, Carroll N, Moxham J, Green M |title=Clinical significance of severe isolated diaphragm weakness |journal=Am. Rev. Respir. Dis. |volume=138 |issue=4 |pages=862–6 |year=1988 |pmid=3202460 |doi=10.1164/ajrccm/138.4.862 |url=}}</ref>  
*Disordered breathing during rapid eye movement sleep  
*Disordered breathing during [[rapid eye movement sleep]]
*


==== Bilateral diaphragmatic paralysis ====
==== Bilateral diaphragmatic paralysis ====
Less common symptoms of bilateral diaphragmatic paralysis include:
Less common symptoms of bilateral diaphragmatic paralysis include:<ref name="pmid19452391">{{cite journal |vauthors=Qureshi A |title=Diaphragm paralysis |journal=Semin Respir Crit Care Med |volume=30 |issue=3 |pages=315–20 |year=2009 |pmid=19452391 |doi=10.1055/s-0029-1222445 |url=}}</ref>
* Acute supine respiratory failure<ref name="pmid872664" />
* Acute supine respiratory failure<ref name="pmid872664" />
* Daytime [[fatigue]]
* [[Morning headaches]]
* [[Confusion]]
*;
*;
*:               
*:               
*


==References==
==References==
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[[Category:Medicine]]
[[Category:Pulmonology]]
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Latest revision as of 21:22, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahda Alihashemi M.D. [2]

Overview

The majority of patients with unilateral diaphragmatic paralysis are asymptomatic. Exertional dyspnea and decreased exercise performance are common symtoms of unilateral diaphragmati paralysis. Less common symtoms of unilateral diaphragmatic paralysis include dyspnea at rest and orthopnea. Dyspnea in supine position and orthopnea are common symtoms of bilateral diphragmatic paralysis. Less common symtoms of bilateral diaphragmatic paralysis include daytime fatigue and confusion.

History and Symptoms

History

Unilateral diaphragmatic paralysis

Patients with unilateral diaphragmatic paralysis may have a positive history of:[1]

Bilateral diphragmatic paralysis

Patients with bilateral diaphragmatic paralysis may have a positive history of :

Common Symptoms

Unilateral diaphragmatic paralysis:[2]

Common symtoms of unilateral diaphragmatic paralysis include:

Bilateral diaphragmatic paralysis

Less Common Symptoms

Unilateral diaphragmatic paralysis

Less common symptoms of unilateral diaphragmatic paralysis include:

Bilateral diaphragmatic paralysis

Less common symptoms of bilateral diaphragmatic paralysis include:[6]

References

  1. ↑ Piehler JM, Pairolero PC, Gracey DR, Bernatz PE (1982). "Unexplained diaphragmatic paralysis: a harbinger of malignant disease?". J. Thorac. Cardiovasc. Surg. 84 (6): 861–4. PMID 6292583.
  2. ↑ Hart N, Nickol AH, Cramer D, Ward SP, Lofaso F, Pride NB, Moxham J, Polkey MI (2002). "Effect of severe isolated unilateral and bilateral diaphragm weakness on exercise performance". Am. J. Respir. Crit. Care Med. 165 (9): 1265–70. doi:10.1164/rccm.2110016. PMID 11991876.
  3. ↑ 3.0 3.1 Sandham JD, Shaw DT, Guenter CA (1977). "Acute supine respiratory failure due to bilateral diaphragmatic paralysis". Chest. 72 (1): 96–8. PMID 872664.
  4. ↑ Kumar N, Folger WN, Bolton CF (2004). "Dyspnea as the predominant manifestation of bilateral phrenic neuropathy". Mayo Clin. Proc. 79 (12): 1563–5. doi:10.4065/79.12.1563. PMID 15595343.
  5. ↑ Laroche CM, Carroll N, Moxham J, Green M (1988). "Clinical significance of severe isolated diaphragm weakness". Am. Rev. Respir. Dis. 138 (4): 862–6. doi:10.1164/ajrccm/138.4.862. PMID 3202460.
  6. ↑ Qureshi A (2009). "Diaphragm paralysis". Semin Respir Crit Care Med. 30 (3): 315–20. doi:10.1055/s-0029-1222445. PMID 19452391.

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