RESEARCH: Vocal fold abductor paralysis

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J Laryngol Otol 1998 Feb;112(2):177-8

Vocal fold abductor paralysis as a solitary and fatal manifestation of

multiple system atrophy.

RG, Gibbin KP, Lowe J.

Department of Otolaryngology, Queens Medical Centre, Nottingham, UK.

A patient is presented who had bilateral abductor vocal fold paralysis

pathologically proven to be due to multiple system atrophy (MSA) in the

absence of other neurological features. MSA is a degenerative neurological

condition that includes olivopontocerebellar atrophy, Shy-Drager syndrome

and striatonigral degeneration. The usual predominant features of MSA are

cerebellar ataxia, autonomic dysfunction and Parkinsonism. Stridor is

present in over one third of patients and has been reported previously as a

presenting symptom in MSA: however previously reported patients have always

gone on to develop other neurological symptoms. The usual investigations of

bilateral abductor vocal fold paralysis caused by MSA will not reveal the

pathological process and we believe that magnetic resonance imaging (MRI) of

the medulla and brain stem and autonomic function tests are probably the

investigations of choice. It is a worthwhile exercise attempting to identify

MSA as the cause of stridor as the prognosis is good in the medium term if

appropriate support is offered.