Unilateral diaphragmatic paralysis | Bilateral diaphragmatic paralysis | |
Neurologic causes | ||
Amyotrophic lateral sclerosis | ✓ | |
Cervical spinal cord dysfunction* | ||
| ✓ | |
| ✓ | ✓ |
Checkpoint inhibitor-associated neurotoxicity | ✓ | |
Critical illness myopathy/neuropathy | ✓ | |
Guillain-Barré syndrome | ✓ | |
Lambert-Eaton myasthenic syndrome | ✓ | |
Multiple sclerosis¶ | ✓ | |
Muscular dystrophies | ✓ | |
Myasthenia gravis | ✓ | |
Neuromyelitis optica spectrum disorder¶ | ✓ | |
Phrenic nerve dysfunction | ||
| ✓ | |
| ✓ | ✓ |
| ✓ | |
| ✓ | ✓ |
| ✓ | ✓ |
| ✓ | |
| ✓ | |
| ✓ | ✓ |
| ✓ | ✓ |
Poliomyelitis and post-polio syndrome | ✓ | |
Systemic causes | ||
Acute intermittent porphyria | ✓ | |
Amyloidosis | ✓ | |
Botulism | ✓ | |
Connective tissue diseases | ||
| ✓ | |
| ✓ | |
| ✓ | |
Hyperthyroidism or hypothyroidism | ✓ | |
Inclusion body myositis | ✓ | |
Pompe disease (lysosomal acid alpha-glucosidase deficiency) | ✓ | |
Malnutrition | ✓ | |
Idiopathic | ✓ | ✓ |
* Conditions causing cervical cord injury include head and neck trauma, cervical spondylosis, compressive tumors, inflammation/demyelination (eg, multiple sclerosis), and ischemia (eg, spinal cord stroke, iatrogenic complication of bronchial artery embolization).
¶ Multiple sclerosis and neuromyelitis optica spectrum disorder may interrupt central motor pathways to the diaphragm via demyelinating lesions in the medulla and cervical spinal cord.
Δ Several disorders can case brachial plexus injury, including neuralgic amyotrophy, radiation therapy, hereditary brachial plexopathy, and nerve blocks; nerves outside the plexus (eg, the phrenic nerve) may be involved.
◊ This overlaps with cervical cord injury and may be caused by cervical spondylosis, cervical compressive tumors, neck trauma, neck surgery, and cervical manipulation therapy.
§ Intrathoracic disease, such as pneumonia, tumors, fibrosis (eg, sclerosing mediastinitis), or mediastinal chest tubes, can compress, inflame, or injure the phrenic nerve locally to cause unilateral paralysis.