Kaufman Matthew R, Willekes Lourens J, Elkwood Andrew I, Rose Michael I, Patel Tushar R, Ashinoff Russell L, Colicchio Alan R
The Institute for Advanced Reconstruction, Shrewsbury, NJ 07702, USA.
Clin Neurol Neurosurg. 2012 Jun;114(5):502-5. doi: 10.1016/j.clineuro.2012.01.048. Epub 2012 Feb 24.
The etiology of diaphragm paralysis is often elusive unless an iatrogenic or traumatic injury to the phrenic nerve can be clearly implicated. Until recently, there has been little interest in the pathophysiology of diaphragm paralysis since few treatment options existed.
We present three cases of symptomatic diaphragm paralysis in which a clear clinico-pathologic diagnosis could be identified, specifically a vascular compression of the phrenic nerve in the neck caused by a tortuous or adherent transverse cervical artery.
In two patients the vascular compression followed a preceding traction injury, whereas in one patient an inter-scalene nerve block had been performed. Following vascular decompression, all three patients regained diaphragmatic motion on fluoroscopic chest radiographs, and experienced a resolution of respiratory symptoms.
We suggest that vascular compression of the phrenic nerve in the neck may occur following traumatic or iatrogenic injuries, and result in symptomatic diaphragm paralysis.
除非能明确涉及膈神经的医源性或创伤性损伤，否则膈神经麻痹的病因往往难以捉摸。直到最近，由于治疗选择有限，人们对膈神经麻痹的病理生理学几乎没有兴趣。
我们报告了3例有症状的膈神经麻痹病例，其中可以明确做出临床病理诊断，具体为迂曲或粘连的颈横动脉导致颈部膈神经的血管受压。
2例患者的血管受压发生在先前的牵引损伤之后，而1例患者曾接受过斜角肌间神经阻滞。血管减压后，所有3例患者在胸部透视时恢复了膈肌运动，并出现呼吸道症状缓解。
我们认为，颈部膈神经的血管受压可能发生在创伤性或医源性损伤之后，并导致有症状的膈神经麻痹。
