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Final Program


Final Program

484 - Vigilance Averting Iatrogenic Respiratory Compromise in Brachial Neuritis

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • GS

    Greg Shinaman, MD

    Resident
    University of Rochester
    Rochester, New York, United States

  • AP

    Annie Philip, MD

    Attending Physician
    University of Rochester Medical Center
    Rochester, New York, United States

    • Co-Author(s)

  • GR

    Giovanni Ramirez Arroyo, MD

    Fellow
    University of Rochester Medical Center
    Rochester, New York, United States

  • SB

    Soroush Besharat, MD

    Resident
    University of Rochester Medical Center
    Rochester, New York, United States

  • RP

    Raj Panchal, DO

    Fellow
    University of Rochester Medical Center
    Rochester, New York, United States

Case Diagnosis: A 37-year-old male with suspected traumatic left-sided brachial plexus injury, associated with pain, weakness, atrophy, and orthopnea. Electromyography and nerve conduction studies revealed subacute left brachial neuritis preferentially affecting the upper and middle trunks more severely. Follow up EMG later confirmed a bilateral phrenic nerve injury. 

Case Description: Three months prior to presentation, the patient encountered resistance while forcibly pulling open a door with his left arm. He immediately experienced severe left arm pain with subsequent weakness leading to arm and shoulder atrophy. One month before presenting to clinic, the patient began experiencing orthopnea. Workup revealed a left subacute brachial neuritis with left phrenic nerve palsy. Treatment included avoiding left stellate ganglion block due to risk of local anesthetic spread to phrenic nerve, as well as gabapentin, pulmonary rehabilitation, neurosurgery and pulmonology consultation, and occupational therapy. 

Discussions: Initially, the patient's respiratory symptoms were evaluated as a separate pathology from the patient's neurologic symptoms since orthopnea is usually associated with cardiac or respiratory pathologies. The patient was referred to the pain clinic for a stellate ganglion block to alleviate the patient’s pain. Consideration of the risk involved in the procedure led the pain physician to strongly suspect phrenic nerve involvement and avoid performing such a procedure since anesthetic spread to an affected phrenic nerve might lead to further paralysis of the diaphragm and subsequent respiratory distress.



Conclusions:

The complexity of diagnosis and treatment in this case arises not only from the atypical manifestation of brachial neuritis but also from the associated respiratory compromise, potentially linked to phrenic nerve injury.



This case highlights the critical need for tailored, patient-centric treatment strategies that balance neurological and respiratory concerns, especially in instances where common interventions for brachial plexus injuries could potentially exacerbate respiratory symptoms. Future research addressing traumatic brachial plexus injuries and respiratory complications could be beneficial.