Invasive Procedures to the Neck and Chest and Hemidiaphragmatic Paralysis: Are They Always Causally Associated?

Three cases of hemidiaphragmatic paralysis are reported. One case was associated with an interscalene brachial plexus block, another with the insertion of an implantable cardioverter defibrillator, and a third case had undergone a coronary artery bypass grafting operation. In only one of these cases, there was a causal association, while in the other two, it was determined that the paralysis was coincidental.

Atypical Neuroleptic Malignant Syndrome With Type 2 Respiratory Failure Treated With Non-invasive Ventilation.

Neuroleptic malignant syndrome (NMS) is characterized by hyperthermia, severe rigidity, and autonomic instability that is life-threatening if not treated promptly by intensive supportive care. However, there have been numerous reports of "atypical NMS" where the diagnostic criteria of NMS are only partially satisfied. We present a case of an elderly male who presented with atypical NMS secondary to antidopaminergic drug administration which precipitated acute respiratory failure.