Cases reported "Respiratory Paralysis"

Filter by keywords:



Filtering documents. Please wait...

1/22. Reversibility of paraneoplastic bilateral diaphragmatic paralysis after nephrectomy for renal cell carcinoma.

    Bilateral diaphragmatic paralysis is usually caused by anatomic lesions of both phrenic nerves (e.g., after cardiothoracic surgery), generalized neurologic diseases (e.g., primary motor neuron disease, amyotrophic lateral sclerosis) or is without a known cause (idiopathic). We report a case of a patient with renal cell carcinoma complicated by an isolated bilateral diaphragmatic paralysis without clinical or electromyographic signs of other muscle or nerve involvement. There has been progressive, though till now partial, recovery of his vital capacity rising from 44% to 72% of predicted values, and maximal inspiratory pressures during the two years following the curative resection of his renal cell carcinoma. We believe this is the first report of a paraneoplastic bilateral diaphragmatic paralysis with actual recovery after tumour therapy.
- - - - - - - - - -
ranking = 1
keywords = vital capacity, capacity
(Clic here for more details about this article)

2/22. A case of frog breathing.

    Frog breathing (glossopharyngeal breathing) is a useful technique employed to increase ventilation when respiratory muscles are paralysed. It is a technique used by many patients with chronic poliomyelitis, yet many chest physicians and physiotherapists are unfamiliar with this breathing maneuver. Glossopharyngeal breathing coordinates movements of the tongue, cheeks and pharynx to force air from the mouth into the lungs. We report a case of glossopharyngeal breathing, demonstrating a 3 fold increase in vital capacity in a subject with chronic poliomyelitis.
- - - - - - - - - -
ranking = 1
keywords = vital capacity, capacity
(Clic here for more details about this article)

3/22. Improved diaphragmatic function after surgical plication for unilateral diaphragmatic paralysis.

    We studied pulmonary function tests, maximal voluntary ventilation, arterial blood gases, and respiratory muscle strength and recruitment pattern in a 37-yr-old symptomatic man before and after surgical plication for a left unilateral diaphragmatic paralysis. After plication, FVC, FEV1, TLC and FRC increased, whereas residual volume remained unchanged. Arterial PO2 improved from 70 to 87 mm Hg. Diaphragmatic strength, as expressed by the maximal transdiaphragmatic pressure increased from 30 to 75 cm H2O, and maximal voluntary ventilation increased from 74 to 123 L/min. Ventilatory muscle recruitment also changed: there was a shift from a positive to a negative delta Pg/delta Ppl slope during tidal breathing. This indicates more effective diaphragmatic recruitment after the procedure. We conclude that surgical plication may be of benefit to patients with symptomatic unilateral diaphragmatic paralysis. The improvement is due to improved respiratory muscle function.
- - - - - - - - - -
ranking = 2.1512186611884E-5
keywords = volume
(Clic here for more details about this article)

4/22. dyspnea as the predominant manifestation of bilateral phrenic neuropathy.

    Phrenic neuropathy associated with brachial neuritis has been well described; however, bilateral phrenic neuropathy with minimal or no involvement of the brachial plexus has not. We review the clinical features, as well as the results of radiographic studies, pulmonary function tests, and electrodiagnostic studies, of 3 patients in whom dyspnea was the presenting manifestation of bilateral phrenic neuropathy. All 3 patients had acute-onset dyspnea, which led to consideration of a pulmonary or cardiac etiology. phrenic nerve conduction studies showed bilateral axonal degeneration of the phrenic nerves. Diaphragmatic paralysis should be considered in the differential diagnosis of acute-onset dyspnea. dyspnea increases typically when the patient lies down, and paradoxical respiration may be present. neck, shoulder, or upper limb pain may occur at onset. Inspiratory pressures may be reduced, but a comparison of the forced vital capacity when the patient is standing and supine is more specific for diaphragmatic weakness. phrenic nerve conduction studies and diaphragmatic electromyography may provide evidence of bilateral involvement. Subclinical evidence of brachial plexus involvement may be present. The prognosis for patients with bilateral phrenic neuropathy may be more favorable than reported previously.
- - - - - - - - - -
ranking = 1
keywords = vital capacity, capacity
(Clic here for more details about this article)

5/22. Selective paralysis of voluntary but not limbically influenced automatic respiration.

    We describe a patient in whom a discrete infarction of the ventral basis pontis caused a complete loss of voluntary respiration, while automatic respiration remained intact. Respiratory excursions, quantified title volumes, and ventilatory response to carbon dioxide were normal, but the patient could not volitionally modify any respiratory parameters. Emotional stimuli producing laughter, crying, or anxiety appropriately modulated automatic respiration. This case established that pathways subserving limbic modulation of automatic respiration descend in the pontine tegmentum and/or lateral portion of the basis pontis spared by this lesion. Furthermore, descending limbic influences on automatic respiration are anatomically and functionally independent of the voluntary respiratory system.
- - - - - - - - - -
ranking = 2.1512186611884E-5
keywords = volume
(Clic here for more details about this article)

6/22. obesity as a possible cause of respiratory failure in bilateral diaphragmatic paralysis. Case report.

    An obese woman with respiratory failure and bilateral diaphragmatic paralysis, was studied in order to investigate the effects of weight loss on respiratory function during wakefulness and sleep. The patient was studied on 5 different occasions during which diurnal blood gas analysis, spirometry, CO2 rebreathing test, nitrogen wash-out test and a nocturnal polysomnographic study were performed. The follow-up period lasted 9 months, during which the patient progressively lost 19 kg. Progressive improvement in awake blood gas tensions (PaO2 21 mmHg, PaCO2 - 16 mmHg) as well as in nocturnal oxyhemoglobin saturation and transcutaneous PCO2 were observed; at the same time only minor changes in responsiveness to CO2 and in lung volumes were found. Conversely alveolar efficiency for CO2, obtained with the nitrogen wash-out test, in the supine posture increased from 81.7 to 90.5%, indicating an improvement in ventilation/perfusion ratio as a possible determinant of blood gas tension improvement during wakefulness and, as a consequence, also during sleep. We conclude that obesity is one possible cause of the occurrence of respiratory failure in bilateral diaphragmatic paralysis.
- - - - - - - - - -
ranking = 2.1512186611884E-5
keywords = volume
(Clic here for more details about this article)

7/22. adult maltase acid deficiency myopathy: treatment with long-term home mechanical ventilation.

    We report a study of an adult with a maltase acid deficiency myopathy. A restrictive respiratory syndrome due to respiratory muscle weakness is associated with paralysis of other muscular groups. In 1982 the patient presented with an alveolar hypoventilation, and mechanical ventilation was required after acute respiratory failure. The patient has received nocturnal mechanical ventilation by tracheostomy at home for 5 years. His clinical status gradually improved in parallel to amelioration of his respiratory condition. Functional respiratory tests improved: initial hypoxia-hypercapnia disappeared, vital capacity increased. The possible mechanisms underlying the improvement are discussed. Increase in pulmonary compliance is an argument to explain the functional improvement observed. Ventilatory response to carbon dioxide was abnormal whereas the ventilatory response to exercise and maxima minute ventilation test were normal. Results are consistent with a respiratory control impairment. The role of mechanical ventilation is difficult to assess in the improvement we observed.
- - - - - - - - - -
ranking = 1
keywords = vital capacity, capacity
(Clic here for more details about this article)

8/22. Intermittent positive pressure ventilation via nasal access in the management of respiratory insufficiency.

    These are preliminary observations of the introduction of a new technique of noninvasive positive pressure respiratory support for patients with subacute or chronic respiratory failure. Clinical situations where intubation or tracheostomy may have been performed were managed by intermittent positive pressure ventilation via nasal access (NIPPV) with a CPAP mask, or a custom constructed Vel-Foam nose piece. Four patients were managed at home with the use of portable volume ventilators. One patient employed the technique while hospitalized with subacute respiratory failure. Two patients, otherwise dependent on mouth intermittent positive pressure ventilation (MIPPV) 24 hours a day, received necessary dental care with NIPPV support. In a large population with a decade or more follow-up, MIPPV was shown to be an effective noninvasive technique to support respiration in patients with the most severe paralytic respiratory failure. Preliminary observations suggest that NIPPV may compare favorably with MIPPV and deserves more widespread study and application.
- - - - - - - - - -
ranking = 2.1512186611884E-5
keywords = volume
(Clic here for more details about this article)

9/22. Complete hemidiaphragmatic paralysis in a patient with multiple sclerosis.

    We present a case history of a patient with definite multiple sclerosis who developed an abrupt onset of unilateral diaphragmatic paralysis, minor increase in lower extremity spasticity and complaint of marked neck stiffness. Her vital capacity during this episode was 600 mL and she was in impending respiratory failure. The diaphragmatic paralysis was demonstrated by radiographic plain films and fluoroscopy. phrenic nerve stimulation was performed during fluoroscopy and the evoked motor response from the diaphragm recorded. There was a normal amplitude diaphragmatic twitch observed with an evoked motor response latency of 1 ms and amplitude of 300 microV. After high dose intravenous steroids, her neck stiffness and spasticity improved, her vital capacity improved to 1500 mL and her diaphragm regained its normal position and movement confirmed by followup radiographic plain films and fluoroscopy. We postulate the presence of a demyelinating plaque in the brainstem fibers descending to the phrenic nucleus as the etiology of the diaphragmatic paralysis. We are unaware of any other case reports of unilateral "upper motor neuron" phrenic nerve paralysis secondary to multiple sclerosis.
- - - - - - - - - -
ranking = 2
keywords = vital capacity, capacity
(Clic here for more details about this article)

10/22. Progressive resistive exercise in weaning high quadriplegics from the ventilator.

    Acutely high level quadriplegics may experience neuromuscular respiratory insufficiency secondary to loss of use of intercostal and abdominal muscles as well as partial involvement of the phrenic nerve. Frequently, these patients will require mechanical ventilation in the initial stages of their treatment. These patients may present difficulty with weaning off the ventilator. In addition, poor respiratory reserve increases the risk of episodic decompensation. We have instituted a progressive resistive exercise protocol (PRE) analogous to PRE commonly used in training skeletal muscle, to wean patients off the ventilator. This involves determining the patient's endurance to the development of fatigue while off the ventilator. patients are re-evaluated weekly until they are weaned from the ventilator. Three case studies are reported in which this protocol was used. In addition to our standard respiratory therapy and physical therapy protocols, values for vital capacity and maximum inspiratory force at admission and post-weaning were recorded. After completion of the programme, none of the patients required re-intubation or subsequent mechanical ventilation. This method of diaphragm training may be useful in weaning high level quadriplegics from the ventilator.
- - - - - - - - - -
ranking = 1
keywords = vital capacity, capacity
(Clic here for more details about this article)
| Next ->


Leave a message about 'Respiratory Paralysis'


We do not evaluate or guarantee the accuracy of any content in this site. Click here for the full disclaimer.