{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T22:01:57Z","timestamp":1780351317068,"version":"3.54.1"},"reference-count":13,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/bmj.com\/coronavirus\/usage"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,5,5]]},"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:p>Neurological complications are well described in SARS-CoV-2, but for the first time we report a case of unilateral diaphragm paralysis occurring early in mechanical ventilation for respiratory failure due to such an infection. The patient subsequently required tracheostomy and ventilator support for 37 days, and had increased breathlessness and an elevated diaphragm at clinic review 9 months later. Dynamic chest radiography demonstrated persistent diaphragm paralysis with an accompanying postural change in lung volumes, and he subsequently underwent surgical plication. This case demonstrates that although persistent dyspnoea is a common feature following SARS-CoV-2 infection and is usually due to deconditioning or persistent parenchymal involvement, it can be due to other causes and needs to be investigated appropriately.<\/jats:p>","DOI":"10.1136\/bcr-2021-243115","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T11:21:04Z","timestamp":1623928864000},"page":"e243115","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Unilateral diaphragm paralysis with COVID-19 infection"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9334-486X","authenticated-orcid":false,"given":"Thomas Simon","family":"FitzMaurice","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK"},{"name":"Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"McCann","sequence":"additional","affiliation":[{"name":"Department of Radiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Walshaw","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK"},{"name":"Institute of Infection and Global Health, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Greenwood","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK"},{"name":"Faculty of Life Sciences, University of Liverpool, Liverpool, UK"},{"name":"Department of Intensive Care, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"2025082703260890000_14.6.e243115.1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.1127"},{"key":"2025082703260890000_14.6.e243115.2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.01039"},{"key":"2025082703260890000_14.6.e243115.3","doi-asserted-by":"crossref","first-page":"3306","DOI":"10.1007\/s00330-020-06731-x","article-title":"Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China","volume":"30","author":"Pan","year":"2020","journal-title":"Eur Radiol"},{"key":"2025082703260890000_14.6.e243115.4","doi-asserted-by":"crossref","first-page":"16","DOI":"10.3390\/diseases6010016","article-title":"Diaphragmatic palsy","volume":"6","author":"Kokatnur","year":"2018","journal-title":"Diseases"},{"key":"2025082703260890000_14.6.e243115.5","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1002\/jmv.25728","article-title":"The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients","volume":"92","author":"Li","year":"2020","journal-title":"J Med Virol"},{"key":"2025082703260890000_14.6.e243115.6","doi-asserted-by":"crossref","first-page":"3039","DOI":"10.1007\/s10072-020-04708-8","article-title":"Neuromuscular presentations in patients with COVID-19","volume":"41","author":"Paliwal","year":"2020","journal-title":"Neurol Sci"},{"key":"2025082703260890000_14.6.e243115.7","article-title":"Respiratory distress in SARS-CoV-2 without lung damage: phrenic paralysis should be considered in COVID-19 infection","volume":"7","author":"Maurier","year":"2020","journal-title":"Eur J Case Rep Intern Med"},{"key":"2025082703260890000_14.6.e243115.8","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1007\/s00134-017-4928-4","article-title":"Critical illness-associated diaphragm weakness","volume":"43","author":"Dres","year":"2017","journal-title":"Intensive Care Med"},{"key":"2025082703260890000_14.6.e243115.9","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1016\/j.chest.2017.08.1157","article-title":"Diaphragm dysfunction in critical illness","volume":"153","author":"Supinski","year":"2018","journal-title":"Chest"},{"key":"2025082703260890000_14.6.e243115.10","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1186\/s13054-016-1418-y","article-title":"Respiratory weakness after mechanical ventilation is associated with one-year mortality - 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