RE: Re: RESEARCH: Different mechanism of vocal cord paralysis between spinocerebellar ataxia and multiple system atrophy

[Guest guest]

Hi Jan,

Vocal chord or vocal fold paralysis can lead to stridor. Stridor is the

sharp intake of breath.

There may be other causes of stridor as well so I don't want to say Jerry

has VCP for sure. I know this can be checked by a specialist if you're

worried.

JBF will jump in on this question I'm sure as he's studied this topic

thoroughly. My take on it is that VCP causes obstruction of the airway

during sleep. (obstructive sleep apnea) There is also " central sleep apnea "

to worry about...the interruption of the brain's signal to the autonomic

nervous system to tell the lungs to breathe. Both kinds seem to plague

people with MSA. I'll let JBF elaborate.

I can't answer your specific questions about CPR or intubation. I do know

of previous list members who have had tracheostomies ... not as emergency

surgery but as a preventative measure for respiratory problems during sleep.

They managed quite well with them, the hole can be plugged and covered up

during the day and left open at night to aid breathing during sleep.

This isn't a fun topic is it? Getting to know your options and coming to

an agreement on whether to try these sorts of procedures before an emergency

happens is a really healthy approach to take, I think.

Extra hugs for you and Jerry,

Pam

Re: RESEARCH: Different mechanism of vocal cord paralysis

between spinocerebellar ataxia and multiple system atrophy

Pam - Is this the Stridor that I hear about? Jerry has that noise he

makes when he breaths, is that the beginning of VCP or is it

something completely different. It was also unclear to me as to the

affect during sleep on patient's with MSA. Obviously, they are

looking for this as a cause of respiratory failure...is this often a

cause of death in MSA? If respiratory failure occurs while in a

medical care situation is it more difficult to intubate a patient

with VCP? What about CPR, is it possible or is there complete

obstruction? Jerry has already gone into Respiratory Failure.

Jan

> J Neurol Sci 2002 May 15;197(1-2):37-43

>

> Different mechanism of vocal cord paralysis between spinocerebellar

ataxia

> (SCA

> 1 and SCA 3) and multiple system atrophy.

>

> Isozaki E, Naito R, Kanda T, Mizutani T, Hirai S.

>

> Department of Neurology, Tokyo Metropolitan Neurological Hospital,

2-6-1,

> Musashidai, Tokyo 183-0042, Fuchu, Japan

>

> While multiple system atrophy (MSA) is frequently associated with

vocal cord

> paralysis (VCP) causing severe respiratory failure, it is still

unknown

> whether

> hereditary types of spinocerebellar degeneration develop similar

laryngeal

> paralysis. We analyzed the laryngeal function from the viewpoints of

> fiberoptic

> laryngoscopy and laryngeal myopathology and then attempted to

clarify the

> difference of the mechanism of VCP among the patients with

spinocerebellar

> ataxia type 1 (SCA 1), type 3 (SCA 3), and MSA. Seven patients with

SCA 1,

> nineteen with SCA 3, and eleven with MSA were studied. Vocal cord

movement

> was

> analyzed by fiberoptic laryngoscopy during wakefulness and diazepam-

induced

> sleep (sleep load test). Paraffin-embedded sections or cryosections

of the

> intrinsic laryngeal muscles from five autopsied cases (one with SCA

1 and

> four

> with SCA 3) were histologically examined. VCP was found in two of

the seven

> SCA

> 1 patients (29%), three of the nineteen SCA 3 patients (16%), and

in nine of

> the

> eleven MSA patients (82%). VCP observed in SCA 1 and SCA 3 was

various in

> the

> severity and showed no exacerbation on sleep load test in all of

the eight

> patients but one SCA 3 patient. In this patient, the findings of

fiberoptic

> laryngoscopy were quite similar to those found in MSA. All the

intrinsic

> laryngeal muscles including cricothyroid (CT), interarytenoid (IA),

and

> posterior cricoarytenoid (PCA) muscles showed neurogenic atrophy in

one

> autopsied SCA 1 and four SCA 3 patients. Our conclusion is that VCP

in SCA 1

> and

> SCA 3 contrasts with that in MSA in its occurrence, response to the

sleep

> load

> test, and the distribution of the neurogenic abnormalities among the

> intrinsic

> laryngeal muscles.

>

> PMID: 11997064 [PubMed - in process]

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[Guest guest]

Not to jump into Pam's boat, but Stridor is a very pronounced audible resipration. If Jerry has that, have him checked for respiratory distress.

Dr. Ray

-- Re: RESEARCH: Different mechanism of vocal cord paralysis between spinocerebellar ataxia and multiple system atrophy

Pam - Is this the Stridor that I hear about? Jerry has that noise he makes when he breaths, is that the beginning of VCP or is it something completely different. It was also unclear to me as to the affect during sleep on patient's with MSA. Obviously, they are looking for this as a cause of respiratory failure...is this often a cause of death in MSA? If respiratory failure occurs while in a medical care situation is it more difficult to intubate a patient with VCP? What about CPR, is it possible or is there complete obstruction? Jerry has already gone into Respiratory Failure.Jan> J Neurol Sci 2002 May 15;197(1-2):37-43> > Different mechanism of vocal cord paralysis between spinocerebellar ataxia> (SCA> 1 and SCA 3) and multiple system atrophy.> > Isozaki E, Naito R, Kanda T, Mizutani T, Hirai S.> > Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1,> Musashidai, Tokyo 183-0042, Fuchu, Japan> > While multiple system atrophy (MSA) is frequently associated with vocal cord> paralysis (VCP) causing severe respiratory failure, it is still unknown> whether> hereditary types of spinocerebellar degeneration develop similar laryngeal> paralysis. We analyzed the laryngeal function from the viewpoints of> fiberoptic> laryngoscopy and laryngeal myopathology and then attempted to clarify the> difference of the mechanism of VCP among the patients with spinocerebellar> ataxia type 1 (SCA 1), type 3 (SCA 3), and MSA. Seven patients with SCA 1,> nineteen with SCA 3, and eleven with MSA were studied. Vocal cord movement> was> analyzed by fiberoptic laryngoscopy during wakefulness and diazepam-induced> sleep (sleep load test). Paraffin-embedded sections or cryosections of the> intrinsic laryngeal muscles from five autopsied cases (one with SCA 1 and> four> with SCA 3) were histologically examined. VCP was found in two of the seven> SCA> 1 patients (29%), three of the nineteen SCA 3 patients (16%), and in nine of> the> eleven MSA patients (82%). VCP observed in SCA 1 and SCA 3 was various in> the> severity and showed no exacerbation on sleep load test in all of the eight> patients but one SCA 3 patient. In this patient, the findings of fiberoptic> laryngoscopy were quite similar to those found in MSA. All the intrinsic> laryngeal muscles including cricothyroid (CT), interarytenoid (IA), and> posterior cricoarytenoid (PCA) muscles showed neurogenic atrophy in one> autopsied SCA 1 and four SCA 3 patients. Our conclusion is that VCP in SCA 1> and> SCA 3 contrasts with that in MSA in its occurrence, response to the sleep> load> test, and the distribution of the neurogenic abnormalities among the> intrinsic> laryngeal muscles.> > PMID: 11997064 [PubMed - in process]If you do not wish to belong to shydrager, you may unsubscribe by sending a blank email to shydrager-unsubscribe