Hemidiaphragmatic paralysis: an unusual complication of cervical spondylosis.

Clinical investigations of a patient having shortness of breath and a paretic left hemidiaphragm revealed compromise of the left C3-4 neural foramen and signs of spondylitic spinal cord compression at that level. After laminectomy, the patient's symptoms and radiologic evidence of hemidiaphragmatic paralysis resolved. This case illustrates the importance of evaluating patients with hemidiaphragmatic paralysis for cervical spondylosis and of evaluating patients with cervical spondylosis for phrenic nerve compromise.

Neuropathy in the upper extremity after open-heart surgery.

Eleven patients with upper-extremity neurological abnormalities underwent open-heart surgery performed through a median sternotomy incision. Seven of the 11 patients were referred in the routine manner to evaluate and treat the neurological problem. The remaining four were part of a consecutively studied group of 11 patients examined prospectively to determine the possible presence of abnormalities. Two of these four patients were asymptomatic. All lesions could be postulated to occur within the brachial plexus, the most common area being the median cord, but lesions were also noted in the posterior and lateral cords and upper trunk. The etiology of the problem appears to be stretching injury of the brachial plexus from retraction of the sternum, which in turn causes retroclavicular displacement of the clavicle. However, it is possible that an ischemic neuropathy could result from intraarterial procedures in some of our patients. The possibility that neurologic deficit may occur in the upper extremity should be considered by physicians who may have the opportunity to evaluate patients who undergo open-heart surgery.

Neurological abnormalities in the leg(s) after use of intraaortic balloon pump: report of six cases.

Six patients from a group of 39 who survived after treatment with the intraaortic balloon pump (lABP) had significant neurological deficits in one or both legs associated with the use of the lABP. The device was used in a group of 89 patients initially for cardiogenic shock but its use has been expanded for patients having the following conditions: preshock; severe congestive heart failure; refractory angina; and for those undergoing open-heart surgery. The six patients who had neurological sequelae had eight lABP insertions into the thoracic aorta through the femoral artery and had neurological abnormalities and/or electromyographic abnormalities in nine lower extremities ranging from a foot drop to almost total paralysis of the lower extremity. The pathophysiology of the neurological deficit is postulated to be an obstruction to blood flow, or thromboemboli, in the femoral artery.