Diaphragmatic paralysis without bulbar or limb paralysis in multiple sclerosis.

A patient is presented in whom disabling pulmonary symptoms in the absence of other significant disability complicated a long-standing course of MS. Clinical presentation and fluoroscopy confirmed the diagnosis of bilateral diaphragmatic paralysis. Magnetic resonance imaging revealed atrophy and extensive white matter changes within the cervical cord. This case is unique in that significant respiratory compromise due to cervical spinal cord involvement by MS was dissociated from bulbar dysfunction or profound limb paresis.