Diagnosis and treatment of phrenic nerve hourglass constriction in patients with Parsonage-Turner syndrome

Travis S CreveCoeur; Christopher J Visco; Mark E Ginsburg; Christopher J Winfree

doi:10.3171/2022.10.FOCVID22105

Diagnosis and treatment of phrenic nerve hourglass constriction in patients with Parsonage-Turner syndrome

Neurosurg Focus Video. 2023 Jan 1;8(1):V7. doi: 10.3171/2022.10.FOCVID22105. eCollection 2023 Jan.

Authors

Travis S CreveCoeur¹, Christopher J Visco², Mark E Ginsburg³, Christopher J Winfree¹

Affiliations

¹ Department of Neurological Surgery, Columbia University Irving Medical Center, New York.
² Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York.
³ Department of Thoracic Surgery, Columbia University Irving Medical Center, New York, New York.

Abstract

Phrenic nerve injury can occur anywhere along its course and clinically results in diaphragm paralysis. Although most patients with Parsonage-Turner syndrome and phrenic nerve dysfunction improve without treatment, some patients do not recover spontaneously. In these cases, an initial autoimmune response produces scarring along the affected nerve(s). This scar, known as an hourglass constriction, causes focal compression of the nerve at the site of the scar, which prevents the nerve from spontaneously recovering. Thus, the authors present a unique case of phrenic nerve injury secondary to Parsonage-Turner syndrome that improved with internal neurolysis. The video can be found here: https://stream.cadmore.media/r10.3171/2022.10.FOCVID22105.

Keywords: Parsonage-Turner syndrome; diaphragm paralysis; phrenic nerve.