Ann Rehabil Med.  2020 Aug;44(4):338-341. 10.5535/arm.19216.

Unilateral Diaphragm Paralysis Associated With Neurosyphilis: A Case Report

• Huh S
• Chung JH
• Kwon HJ
• Ko HY

• KMID: 2505394
• DOI: http://doi.org/10.5535/arm.19216

Abstract

Diaphragm dysfunction can originate from various etiologies, and bilaterality of the dysfunction depends on the cause. Symptoms of diaphragm dysfunction vary depending on the degree of phrenic nerve denervation, spinal cord lesion, and involvement of the diaphragm. Several infectious diaphragmatic dysfunctions have been reported, including the human immunodeficiency virus, poliovirus, West Nile virus, and dengue virus. Here, we report a case of unilateral diaphragm paralysis in a 34-year-old man with neurosyphilis.

Keyword

Neurosyphilis; Diaphragm; Phrenic nerve

Figure

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  Fig. 1. Initial ultrasonography of the right diaphragm. Ultrasonography was performed in two different views. The hyperechoic right diaphragm in the 7th intercostal space was identified at the distal end of the liver, which served as an acoustic window. (A) The excursion of the diaphragm was viewed through M-mode and there was no movement of the right diaphragm. (B) The thickness of the right diaphragm is viewed through B-mode and the value revealed 0.22 cm.

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  Fig. 2. Nerve conduction studies of (A) right and (B) left phrenic nerves. The compound muscle action potential of the right phrenic nerve showed a decreased amplitude (0.1 mV), while the left showed a normal amplitude (0.7 mV).

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  Fig. 3. Follow-up ultrasonography of the right diaphragm. (A) The follow-up ultrasonography after 2 months showed a paradoxical movement of the right diaphragm, which indicated complete paralysis. (B) The thickness of the right diaphragm revealed 0.15 cm.

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