diaphragm
Location of the lesion | Disease | Comment |
Cerebral cortex | Vascular accident | The respiratory motor neurons of the pyramidal tract (corticospinal) are scattered throughout a wide area of the cortex, so they rarely affect the diaphragm. |
Internal capsule | Vascular acaident Arnold-Chiari disease | Vascular accidents located in the brain stem can cause hypoventilation due to involvement of the bulbospinal tract, affecting the automatic control of respiration. |
Central nervous system | Multiple sclerosis | Uncommon cause of diaphragmatic involvement. The main implication occurs in the expiratory musculature. It usually appears in patients in very advanced stages with severe alteration of mobility. The initial clinical presentation as isolated diaphragmatic paralysis is rare and is usually bilateral. |
Spinal cord | Traumatic degenerative (severe spondylosis) | If the lesion is at the level of C3-C5, in addition to the diaphragmatic involvement, other major muscles of inspiration may be affected. When the injury affects the C2 level or higher, the need for ventilatory support is almost inevitable and, as we move away from this level, the probability decreases and is rareły needed in lesions below C5. |
Motor neurons | Post-polio syndrome Amyotrophic lateral sclerosis Syringomyelia Paraneoplastic neuropathy assodiated with antibodies-HU Radiation post-irradiation Spinal muscular atrophy | The post-polio syndrome can manifest itself years after its recovery and affect the same muscle groups as new ones. Amyotrophic lateral sclerosis produces secondarily atrophy and weakness of the respiratory muscles. Diaphragmatic involvement may be the first manifestation or develop throughout the disease. It is bilateral and its involvement could be valuable even before the respiratory symptoms begin. |
Brachial plexus | Traumatic latrogenic (anaesthetic blockages, obstetric procedures, chiropractic manipulations of the neck, radiotherapy) Idiopathic | All of these can cause diaphragmatic paralysis. |
Phrenic | Trauma Compression/infiltration (mediastinal neoplasms) Guillain-Barré Infection (Herpes-Zoster virus, pneumonias, Lyme disease, HIV infection) Amyotrophic neuralgia (Parsonage-Turner) Thoracic surgeries Others [malnutrition, diabetes, hypothyroidism, benign thyroid hypertrophy, porphyria, vasculitis, Charcot-Marie-Toot disease] Idiopathic | Guillain-Barré disease is the most frequent cause of acute respiratory muscle paralysis. More than 25% of patients will need non-irvasive ventilation. Infection with Herpes-Zoster virus produces diaphragmatic paralysis if it affects the cervical territory and is usually ipsilateral and usually permanent. Amyotrophic neuralgia presents pain and flaccid paralysis of the shoulder muscles. It is associated with both uni and bilateral diaphragmatic involvement. In idiopathic causes the paralysis can be unilateral or bilateral. |
Lung | Asthma and chronic obstructive pulmonary disease | The existing pulmonary hyperinflation can deteriorate the diaphragmatic function since the diaphragm does not have an optimal length for its normal functioning. |
Neuromuscular junction | Myasthenia gravis, botulism, Lambert-Eaton syndrome | During an acute myasthenic crisis there may be acute respiratory failure that will require invasive ventilation. |
Muscular | Muscular dystrophies, steroid myopathy, Pompe disease, myositis, mechanical ventilation | In the presence of a diaphragmatic paralysis, acid alfa-glucosidase enzyme levels should be determined to discard late-onset Pompe disease (16.7%) prevalence. Mechanical ventilation, both invasive and non-invasive, can produce atrophy of the diaphragm due to disuse. |
登录后 PLUS 会员 可查看完整内容
微信扫一扫
成为会员后
查看完整内容
文献评审日期:2022-09-14