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Specific causes of diaphragmatic paralysis

Specific causes of diaphragmatic paralysis
  Unilateral diaphragmatic paralysis Bilateral diaphragmatic paralysis
Neurologic causes
Amyotrophic lateral sclerosis   ✓
Cervical spinal cord dysfunction*
  • Complete
   ✓
  • Partial
 ✓ ✓
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
  • Blunt trauma
 ✓  
  • Brachial plexopathyΔ
 ✓ ✓
  • Cardiac surgery causing cold or stretch injury
 ✓  
  • Cervical nerve root injury (C3, C4, and/or C5)◊
 ✓ ✓
  • Idiopathic phrenic neuropathy
 ✓ ✓
  • Intrathoracic disease§
 ✓  
  • Paraneoplastic neuropathy
   ✓
  • Postinfectious neuropathy
 ✓ ✓
  • Radiation therapy
 ✓ ✓
Poliomyelitis and post-polio syndrome   ✓
Systemic causes
Acute intermittent porphyria   ✓
Amyloidosis   ✓
Botulism   ✓
Connective tissue diseases
  • Dermatomyositis, polymyositis
   ✓
  • Mixed connective tissue disease
   ✓
  • Systemic lupus erythematosus
   ✓
Hyperthyroidism or hypothyroidism   ✓
Inclusion body myositis   ✓
Pompe disease (lysosomal acid alpha-glucosidase deficiency)   ✓
Malnutrition   ✓
Idiopathic ✓ ✓
This table represents the distribution of etiologies, shared and different, between unilateral and bilateral diaphragmatic paralysis.


* 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.

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