Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

An obese woman presenting as vocal cord abductor paralysis and floppy arytenoid associated with early signs of multiple system atrophy

Hideki Sakuta, M.D.1), Masayuki Miyamoto, M.D., Ph.D.1), Keisuke Suzuki, M.D., Ph.D.1), Tomoyuki Miyamoto, M.D., Ph.D.2), Itsuo Nakajima, M.D., Ph.D.3), Toshiki Nakamura, M.D., Ph.D.4) and Koichi Hirata, M.D., Ph.D.1)

1)Department of Neurology, Dokkyo Medical University
2)Department of Neurology, Dokkyo Medical University Koshigaya Hospital
3)Department of Otolaryngology, Dokkyo Medical University
4)Department of Neurology, Rehabilitation Amakusa Hospital

In multiple system atrophy (MSA), sleep-related breathing disorders are commonly observed, including vocal cord abductor paralysis (VCAP), which can cause sudden death. In its early stage, VCAP occurs only during sleep, but as the disease progresses, it appears when both awake and asleep. We encountered a 59-year-old obese woman who had been under continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea syndrome (OSAS) for approximately one year but later developed acute respiratory failure because of VCAP. VCAP was the predominant finding that led to the diagnosis of MSA in our patient. On laryngoscopic examination, the movement of the patient's larynx was normal during wakefulness, but VCAP, paradoxical movements of the vocal cord and a floppy arytenoid were observed during drug-induced sleep. We suggest that detection of VCAP and laryngopharyngeal abnormalities such as floppy arytenoid in the early stage of MSA is important for determining treatment options.
Supplemental video: During expiration, the abduction of the vocal cords is observed, but limited. During inspiration paradoxical vocal cord movement is noted. The bilateral vocal cords are fixed in a midline position, and the arytenoid is prolapsed over the larynx (floppy arytenoid).
Supplemental video
Full Text of this Article in Japanese PDF (411K)

(CLINICA NEUROL, 52: 421|424, 2012)
key words: multiple system atrophy, vocal cord abductor paralysis, stridor, tracheostomy, obesity

(Received: 26-Jul-11)