Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

A case of Guillain-Barré syndrome with unilateral diaphragmatic nerve palsy that was longitudinally evaluated using multiple examinations

Tomohito Ohashi, M.D.1), Tomoo Mano, M.D., Ph.D.1)2), Naohiko Iguchi, M.D.1), Hitoki Nanaura, M.D., Ph.D.1), Takao Kiriyama, M.D., Ph.D.1) and Kazuma Sugie, M.D., Ph.D.1)

1) Department of Neurology, Nara Medical University
2) Department of Rehabilitation Medicine, Nara Medical University

The patient, a 50-year-old woman, presented with fever and diarrhea in early July, X. One week later, she noticed muscle weakness in both lower extremities, which upon examination was found to be dominant in the distal muscles, with associated loss of tendon reflexes. We diagnosed the case as Guillain-Barré syndrome. After admission, the patient experienced decreased oxygenation, and a chest X-ray indicated elevation of the left hemidiaphragm. The phrenic nerve conduction studies revealed laterality of the amplitude of compound muscle action potential, and diaphragmatic ultrasonographic examination revealed decreased left diaphragmatic wall motion. We diagnosed the patient with unilateral diaphragmatic nerve palsy and initiated intravenous immunoglobulin and methylprednisolone treatment. After 2 weeks, the patient demonstrated good clinical recovery, increased diaphragmatic nerve amplitude, and improved diaphragmatic movement. We evaluated the longitudinal clinical course of unilateral diaphragmatic nerve palsy in the patient using nerve conduction tests and diaphragmatic echocardiography. The longitudinal evaluation allowed us to assess the pathological condition more sensitively so that the prognosis could be predicted accurately.
Full Text of this Article in Japanese PDF (1378K)

(CLINICA NEUROL, 62: 805−809, 2022)
key words: Guillain-Barré syndrome, phrenic nerve palsy, nerve conduction study, diaphragmatic ultrasound examination

(Received: 20-Mar-22)