Vocal cord abductor paralysis in multiple system atrophy

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Rinsho Shinkeigaku 1996 Apr;36(4):529-33

[Vocal cord abductor paralysis in multiple system atrophy--paradoxical

movement

of vocal cords during sleep]

[Article in Japanese]

Isozaki E, Hayashi M, Hayashida T, Tanabe H, Hirai S.

Department of Neurology, Tokyo Metropolitan Neurological Hospital.

Bilateral vocal cord abductor paralysis (VCAP) is frequently associated with

multiple system atrophy (MSA) and the early clinical manifestation of VCAP

is

nocturnal inspiratory stridor simulating heavy snoring observed in patients

with

obstructive sleep apnea syndrome. We examined six MSA patients with

nocturnal

stridor and four disease controls including sleep apnea syndrome. Vocal cord

movements were analyzed by laryngofiberscopy during both wakefulness and

sleep

induced by intravenous administration of diazepam. The results were as

follows:

First, the stenotic portion in the upper airway tract was the larynx (the

vocal

cords) in MSA patients with stridor, while the soft palate or the pharynx in

the

disease controls. Second, in the MSA patients, while awake-laryngofiberscopy

showed abduction restriction suggestive of VCAP in only one of the six

patients,

sleep-laryngofiberscopy showed obvious paradoxical movement of the vocal

cord in

all the rests, where the vocal cords abducted in expiration and adducted in

inspiration. In addition, there were two patterns in the inspiratory vocal

cord

position during sleep: one pattern where vocal glottis was still opening at

the

posterior one-third area and the other pattern where vocal glottis was

almost

completely closed through total length of the cords. Tracheostomy should be

considered in the latter stage of VCAP.

PMID: 8810844 [PubMed - indexed for MEDLINE]

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Pam,

Sorry I have not said this sooner but THANK YOU for all of this wonderful

research that you have done about this subject. I have sent much of it

along to my doctor.

Deborah

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