Role of phrenic nerve in respiratory distress secondary to Lyme neuroborreliosis
Gautam Dagur 1,   Kelly Warren 1,   Min Lea 1,   Sahana Pentyala 2,   Krupali Chokshi 2,   Srinivas Pentyala 1, 3, 2,   Sardar A. Khan 1, 3, 4  
More details
Hide details
Department of Physiology and Biophysics, SUNY at Stony Brook, New York, United States
Department of Anesthesiology, SUNY at Stony Brook, New York, United States
Department of Urology, SUNY at Stony Brook, New York, United States
Department of Neurology, SUNY at Stony Brook, New York, United States
Sardar A. Khan   

HSC Level 9 Room 040, SUNY at Stony Brook, Stony Brook, NY, 11794-8093, United States. Tel.: +1 631 987 0132; fax: +1 631 44 7620.
Submission date: 2015-11-09
Acceptance date: 2016-04-07
Online publication date: 2016-05-21
Publication date: 2019-12-15
Pol. Ann. Med. 2017;24(1):72–76
Critical importance of phrenic nerve, in patients with Lyme disease is discussed.

This paper addresses the critical importance of phrenic nerve and Lyme disease.

Material and methods:
Medline searches were conducted in context of phrenic nerve, Lyme neuroborreliosis, thoracic diaphragm, and respiratory distress.

Results and discussion:
The advancements in treatment options in Lyme disease were reviewed using current literature. Applied anatomy of the phrenic nerve and its dysfunction in neuroborreliosis is described in the article.

This paper reviews the literature pertaining to the importance of the phrenic nerve in Lyme disease.

Wegratefully acknowledge literature research assistance from Mrs. Wendy Isser and Ms. Grace Garey.
The authors declare that they have no conflict of interest.
Abbott RA, Hammans S, Margarson M, Aji BM. Diaphragmatic paralysis and respiratory failure as a complication of Lyme disease. J Neurol Neurosurg Psychiatry. 2005;76(9):1306–1307.
Kulkarni NV. Clinical Anatomy for Students: Problem Solving Approach. New Delhi: Jaypee Brothers Publishers; 2007.
Hansen K, Crone C, Kristoferitsch W, Lyme neuroborreliosis. Said G, Krarup C, eds. Handbook of Clinical Neurology. Vol 115. Edinburgh: Elsevier; 2013:559–575.
Pornrattanamaneewong C, Limthongthang R, Vathana T, Kaewpornsawan K, Songcharoen P, Wongtrakul S. Diaphragmatic height index: new diagnostic test for phrenic nerve dysfunction. J Neurosurg. 2012;117(5):890–896.
Lakhani M, Saiful F, Bekheit S, Kowalski M. Use of intracardiac echocardiography for early detection of phrenic nerve injury during cryoballoon pulmonary vein isolation. J Cardiovasc Electrophysiol. 2012;23(8):874–876.
Canbaz S, Turgut N, Halici U, Duran E. Diagnosis of phrenic nerve injury after cardiac surgery. Ann Thorac Surg. 2004;78(4):1517.
Canbaz S, Turgut N, Halici U, Balci K, Ege T, Duran E. Electrophysiological evaluation of phrenic nerve injury during cardiac surgery – a prospective, controlled, clinical study. BMC Surg. 2004;4:2.
Deng Y, Byth K, Paterson HS. Phrenic nerve injury associated with high free right internal mammary artery harvesting. Ann Thorac Surg. 2003;76(2):459–463.
Aguirre VJ, Sinha P, Zimmet A, Lee GA, Kwa L, Rosenfeldt F. Phrenic nerve injury during cardiac surgery: mechanisms, management and prevention. Heart Lung Circ. 2013;22(11):895–902.
Harris K, Maniatis G, Siddiqui F, Maniatis T. Phrenic nerve injury and diaphragmatic paralysis following pacemaker pulse generator replacement. Heart Lung. 2013;42(1):65–66.
Ahn EJ, Baek CW, Shin HY, Kang H, Jung YH. Phrenic nerve palsy after internal jugular venous catheter placement. Korean J Anesthesiol. 2012;63(2):183–184.
Ataka K, Chihara H, Yoshimura M, et al. [Phrenic nerve palsy following open-heart surgery]. Rinsho Kyobu Geka Jpn Ann Thorac Surg. 1987;7:121–124.
Alexander Jr JC. Phrenic nerve dysfunction following coronary artery bypass grafting: an aggravation or a real problem? Chest. 1998;113(1):2–3.
Brodaty D, Bical O, Bachet J, et al. [Cold-induced paralysis of the phrenic nerve in open-heart surgery]. Nouv Presse Med. 1981;10:3137–3140.
Andrade JG, Dubuc M, Ferreira J, et al. Histopathology of cryoballoon ablation-induced phrenic nerve injury. J Cardiovasc Electrophysiol. 2014;25(2):187–194.
Bunch TJ, Bruce GK, Mahapatra S, et al. Mechanisms of phrenic nerve injury during radiofrequency ablation at the pulmonary vein orifice. J Cardiovasc Electrophysiol. 2005;16(12):1318–1325.
Sánchez-Quintana D, Ho SY, Climent V, Murillo M, Cabrera JA. Anatomic evaluation of the left phrenic nerve relevant to epicardial and endocardial catheter ablation: implications for phrenic nerve injury. Heart Rhythm. 2009;6(6):764–768.
Al-Qattan MM, Clarke HM, Curtis CG. The prognostic value of concurrent phrenic nerve palsy in newborn children with Erb's palsy. J Hand Surg Br. 1998;23(2):225.
Georgiev S, Konstantinov G, Latcheva A, Mitev P, Mitev I, Lazarov S. Phrenic nerve injury after paediatric heart surgery: is aggressive plication of the diaphragm beneficial? Eur J Cardiothorac Surg. 2013;44(5):808–812.
de Jong AA, Manni JJ. Phrenic nerve paralysis following neck dissection. Eur Arch Otorhinolaryngol. 1991;248(3):132–134.
Karaoğlu P, Yiş U, Öztura I, et al. Phrenic nerve palsy associated with brachial plexus avulsion in a pediatric patient with multitrauma. Pediatr Emerg Care. 2013;29(8):922–923.
Ozdemir R, Oğuz S, Uras N, et al. Phrenic nerve injury due to thoracentesis for TPN effusion in a preterm newborn: consecutive two unusual complications. Tuberk Toraks. 2011;59(4):384–387.
Stramrood CA, Blok CA, van der Zee DC, Gerards LJ. Neonatal phrenic nerve injury due to traumatic delivery. J Perinat Med. 2009;37(3):293–296.
Shiohama T, Fujii K, Hayashi M, et al. Phrenic nerve palsy associated with birth trauma – case reports and a literature review. Brain Dev. 2013;35(4):363–366.
Ferdinande P, Bruyninckx F, Van Raemdonck D, Daenen W, Verleden G, Leuven Lung Transplant G. Phrenic nerve dysfunction after heart–lung and lung transplantation. J Heart Lung Transplant. 2004;23(1):105–109.
Ostrowska M, de Carvalho M. Prognosis of phrenic nerve injury following thoracic interventions: four new cases and a review. Clin Neurol Neurosurg. 2012;114(3):199–204.
Helps BA, Ross-Russell RI, Dicks-Mireaux C, Elliott MJ. Phrenic nerve damage via a right thoracotomy in older children with secundum ASD. Ann Thorac Surg. 1993;56(2):328–330.
Işlek I, Akpolat T, Danaci M. Phrenic nerve palsy caused by subclavian vein catheterization. Nephrol Dial Transplant. 1998;13(4):1023–1025.
Taşkınlar H, Naycı A, Çömelekoğlu Ü, Polat G, Zorludemir S, Avlan D. Intestinal ischemia–reperfusion induced diaphragm contractility dysfunction: electrophysiological and ultrastructural study in a neonatal rat model. J Pediatr Surg. 2016;51(3):354–359.
Henderson PW, Spigland NA. Right phrenic nerve injury as a complication of tracheoesophageal fistula repair. Pediatr Crit Care Med. 2010;11(5):e52–e54.
De A, Hayes JE. Persistent phrenic nerve paresis after interscalene block: a ‘‘triple crush’’ hypothesis of nerve injury. Reg Anesth Pain Med. 2013;38(6):553.
McAlister VC, Grant DR, Roy A, et al. Right phrenic nerve injury in orthotopic liver transplantation. Transplantation. 1993;55(4):826–830.
Odita JC, Khan AS, Dincsoy M, Kayyali M, Masoud A, Ammari A. Neonatal phrenic nerve paralysis resulting fromintercostal drainage of pneumothorax. Pediatr Radiol. 1992;22(5):379–381.
Ulku R, Onat S, Balci A, Eren N. Phrenic nerve injury after blunt trauma. Int Surg. 2005;90(2):93–95.
Fisher MA, Leehey DJ, Gandhi V, Ing T. Phrenic nerve palsies and persistent respiratory acidosis in a patient with diabetes mellitus. Muscle Nerve. 1997;20(7):900–902.
Odell JA, Kennelly K, Stauffer J. Phrenic nerve palsy and Parsonage–Turner syndrome. Ann Thorac Surg. 2011;92(1):349–351.
Abboud L, El SF, Takubo T, Byrd Jr RP, Roy TM. Phrenic nerve involvement in Charcot–Marie–Tooth disease. Tenn Med. 2005;98(10):495–497.
Barraclough A, Triplett J, Tuch P. Brachial neuritis with phrenic nerve involvement. J Clin Neurosci. 2012;19(9):1301–1302.
Manning PB, Thompson NW. Bilateral phrenic nerve palsy associated with benign thyroid goiter. Acta Chir Scand. 1989;155(8):429–431.
Khatchikian CE, Nadelman RB, Nowakowski J, et al. Public health impact of strain specific immunity to Borrelia burgdorferi. BMC Infect Dis. 2015;15(October):472.
Hatchette TF, Johnston BL, Schleihauf E, et al. Epidemiology of Lyme disease, Nova Scotia, Canada, 2002–2013. Emerg Infect Dis. 2015;21(10):1751–1758.
Ishaq S, Quinet R, Saba J. Phrenic nerve paralysis secondary to Lyme neuroborreliosis. Neurology. 2002;59(11):1810–1811.
Winterholler M, Erbguth FJ. Tick bite induced respiratory failure. diaphragm palsy in Lyme disease. Intensive Care Med. 2001;27(6):1095.
van Egmond ME, Luijckx GJ, Kramer H, Benne CA, Slebos DJ, van Assen S. Diaphragmatic weakness caused by neuroborreliosis. Clin Neurol Neurosurg. 2011;113(2):153–155.
Djukic M, Larsen J, Lingor P, Nau R. Unilateral phrenic nerve lesion in Lyme neuroborreliosis. BMC Pulm Med. 2013;13:4.
Cunha BA. Minocycline versus doxycycline in the treatment of Lyme neuroborreliosis. Clin Infect Dis. 2000;30(1):237–238.
Dotevall L, Hagberg L. Successful oral doxycycline treatment of Lyme disease-associated facial palsy and meningitis. Clin Infect Dis. 1999;28(3):569–574.
Pfister HW, Preac-Mursic V, Wilske B, Einhaupl KM. Cefotaxime vs penicillin G for acute neurologic manifestations in Lyme borreliosis. A prospective randomized study. Arch Neurol. 1989;46(11):1190–1194.
Faul JL, Ruoss S, Doyle RL, Kao PN. Diaphragmatic paralysis due to Lyme disease. Eur Respir J. 1999;13(3):700–702.
Centers for Disease Control and Prevention. Lyme Disease. Diagnosis and Testing. 2015. diagnosistesting Accessed 01.04.16.
Centers for Disease Control and Prevention. Lyme Disease. Treatment. 2015. Accessed 01.04.16.