Brachial Neuritis Presenting with Arm Pain, Dyspnea and an Elevated Diaphragm: Case Report

臂神經炎以上臂疼痛，呼吸困難及橫隔上升表現：病例報告

陳俊谷(Chun-Gu Chen) ； 高中錚(Chung-Cheng Kao) ； 蔡耀德(Yao-Te Chai) ； 陳俊安(Chun-An Cheng)

《Journal of Emergency Medicine, Taiwan》 10卷4期 (2008/12) Pp. 139-143

摘要

臂神經炎是一少見的神經症狀，臨床特色為急性嚴重肩部及手臂疼痛；接續發生無力、感覺喪失及萎縮，多半是由於臂神經叢發炎造成。急性症狀可能只有疼痛。臂神經炎需和其他肩部疼痛致病因作鑑別以確定診斷。因為有很多更常見的疾病所以在急診室易被忽略。報告一名沒有肺部疾病之臂神經炎和右半側橫隔麻痺的46歲女性以呼吸困難表現，右側橫隔神經電生理檢查對刺激沒有反應，給予復健治療及保守性止痛藥，之後症狀改善。回顧臂神經炎併橫隔神經病變的之臨床特色，放射線檢查，肺功能檢查和神經電生理檢查。總而言之，診斷需依據病史、臨床表現，生化檢查及神經電生理檢查。治療包括給予保守性止痛藥及復健治療，且症狀多於數個月內改善，預後相當良好。早期診斷並給予適當的治療可避免不必要之手術及併發症，並向病患解釋其病情及預後，使病患免於焦慮恐懼。

關鍵字

臂神經炎 ； 呼吸困難 ； 麻痺 ； 橫隔神經病變

並列摘要

Brachial neuritis is an uncommon, idiopathic neurologic syndrome characterized by acute onset of severe shoulder and arm pain followed by muscle weakness, sensory loss, and atrophy. It is caused by inflammation within the brachial plexus. Pain may be the only acute symptom. Differentiating brachial neuritis from other causes of shoulder pain is necessary to confirm the diagnosis. This diagnosis may be overlooked in the emergency room, because other conditions are much more common. We report a 46 year-old woman with brachial neuritis and right diaphragmatic paralysis who presented with dyspnea in the absence of lung disease. Phrenic nerve conduction study showed no response to stimulation on the right side. Physical therapy and analgesics were prescribed and got better later. We review the clinical features, as well as the results of radiographic study, pulmonary function tests and electrodiagnostic study of this patient in whom dyspnea was the presenting manifestation of phrenic neuropathy. In general, the diagnosis is based on history, clinical findings, laboratory tests and electrodiagnostic tests. Treatment includes analgesics and physical therapy, with resolution of symptoms usually occurring in several months. The prognosis is excellent. Early diagnosis and adequate treatment are important to avoid unnecessary investigation, prevent complications, and reassure the patient.

並列關鍵字

brachial neuritis ； dyspnea ； paralysis ； phrenic neuropathy