Abstract
Respiratory failure requiring mechanical ventilation has been reported in patients with bilateral diaphragmatic paralysis due to CIDP. We report a case of CIDP that progressed to respiratory failure with normal chest radiography despite unilateral diaphragmatic paralysis. This manifestation would have been missed if ultrasound was not employed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-015-0033-5) contains supplementary material, which is available to authorized users.
Highlights
Diaphragmatic paralysis can result from neurological diseases affecting the phrenic nerve including Guillain–Barré syndrome, and it has been described in chronic inflammatory demyelinating polyneuropathy (CIDP) [1, 2]
We report a case of CIDP that manifested an alternating hemidiaphragmatic paralysis
He was discharged from the hospital to the care of the Haem-Oncology team as an outpatient. This case reports the unusual finding of alternating phrenic nerve palsy in CIDP manifested on bedside diaphragmatic ultrasound in real time
Summary
Diaphragmatic paralysis can result from neurological diseases affecting the phrenic nerve including Guillain–Barré syndrome, and it has been described in chronic inflammatory demyelinating polyneuropathy (CIDP) [1, 2]. Case presentation A 42-year-old male presented to the emergency department following acute onset of breathlessness He had a history of unexplained lower limb paraplegia at 29 years of age. Over 4 months prior to admission, the patient had multiple presentations with variable During this admission, the patient developed progressive severe upper limb weakness, areflexia and altered sensation. The patient developed hypercarbic respiratory failure and was admitted to ICU where he received non-invasive ventilation. Within 24 h, the patient’s gas exchange improved dramatically and ventilation mode was quickly weaned from SIMV to PSV mode only He was receiving fractional inspired oxygen 30 %, positive end-expiratory pressure of 5 cmH2O and pressure support of 15 cmH2O. As part of the clinical assessment, respiratory ultrasound was performed which revealed an akinetic left hemidiaphragm, a mobile right
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