Parsonage-Turner syndrome: an unusual cause of hemidiaphragmatic paralysis

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Parsonage-Turner syndrome is a well-defined, idiopathic neurological disorder characterized by abrupt onset of unilateral shoulder girdle and arm pain followed by weakness, wasting and atrophy of the proximal or, occasionally, distal musculature of the involved extremity. Several unusual features of the syndrome have been described.1 In this report, we present another of these variations, hemidiaphragmatic paralysis.

Case report

A 42-year-old right-handed woman presented for evaluation of right shoulder and arm pain. Six weeks earlier she had suffered from a flulike illness characterized by fever, myalgia and nausea. Shortly thereafter, she experienced neck pain, which radiated across the epaulet of the right shoulder into the shoulder itself and subsequently down into the right arm and right anterior chest. The pain was initially severe, requiring narcotic analgesics for relief. Two weeks after the onset of discomfort, she experienced weakness in the right upper extremity. She had been treated for arterial hypertension in the past. She was initially hospitalized at another institution for suspected cervical disc disease and cervical radiculopathy.

General admission physical examination revealed an alert, cooperative, pleasant woman complaining of pain and weakness in the right arm. The blood pressure varied between 180/110 and 160/110 mm Hg. The general physical examination was otherwise within normal limits. Neurologic abnormalities consisted of early hypertensive retinal change noted in both fundi. Weakness was noted in the right supraspinatus, deltoid, biceps and serratus anterior with winging of the right scapula. Right biceps reflex was absent.

Admission chest radiograph showed elevation and fixation of the right . . .



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