Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-28T16:03:54.908Z Has data issue: false hasContentIssue false
  • English
  • Français

Vocal fold abductor paralysis as a solitary and fatal manifestation of multiple system atrophy

Published online by Cambridge University Press:  29 June 2007

R. G. M. Hughes ,
K. P. Gibbin  and
J. Lowe
R. G. M. Hughes*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Queens Medical Centre, Nottingham, UK.
K. P. Gibbin
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Queens Medical Centre, Nottingham, UK.
J. Lowe
Affiliation:
Department of Pathology, Queens Medical Centre, Nottingham, UK.
*
Address for correspondence: Mr R. G. M. Hughes, Department of Otolaryngology – Head and Neck Surgery, Queen's Medical Centre, University Hospital, Nottingham NG7 2UH.
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Keywords

Vocal fold paralysisMultiple system atrophy (MSA)
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 112 , Issue 2 , February 1998 , pp. 177 - 178
Copyright
Copyright © JLO (1984) Limited 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bannister, R., Gibson, W., Michaels, L., Oppenheimer, D. R. (1981) Laryngeal abductor paralysis in multiple system atrophy. A report on three necropsied cases, with observations on the laryngeal muscles and the nuclei ambigui. Brain 104: 351–368.CrossRefGoogle ScholarPubMed
Bawa, R., Ramadan, H. H., Wetmore, S. J. (1993) Bilateral vocal cord paralysis with Shy-Drager syndrome. Otolaryngology – Head and Neck Surgery 109: 911–914.CrossRefGoogle ScholarPubMed
Eardley, I., Quinn, N. P., Fowler, C. J., Kirby, R. S., Parkhouse, H. F., Marsden, C. D., Bannister, R. (1989) The value of urethral spincter electromyography in the differential diagnosis of Parkinsonism. British Journal of Urology 64: 360–362.CrossRefGoogle Scholar
Gilmartin, J. J., Wright, A. J., Cartlidge, N. E. F., Gibson, G. J. (1984) Upper airway obstruction complicating the Shy-Drager syndrome. Thorax 39: 313–314.CrossRefGoogle ScholarPubMed
Kew, J., Gross, M., Chapman, P. (1990) Shy-Drager syndrome presenting as isolated paralysis of vocal cord abductors. British Medical Journal 300: 1441.CrossRefGoogle ScholarPubMed
Martinovits, G., Leventon, G., Goldhammer, Y., Sadeh, M. (1988) Vocal cord paralysis as a presenting sign in the Shy-Drager syndrome. Journal of Laryngology and Otology 102: 280–281.CrossRefGoogle ScholarPubMed
Papp, M. I., Kahn, J. E., Lantos, P. L. (1989) Glial cytoplasmic inclusions in the CNS of patients with multiple system atrophy (striatonigral degeneration, olivopontocerebellar atrophy and Shy-Drager syndrome). Journal of Neurological Sciences 94: 79–100.CrossRefGoogle ScholarPubMed
Pastakia, B., Polinsky, R., Di Chiro, G., Thayer Simmons, J., Brown, R., Wener, L. (1986) Multiple system atrophy (Shy-Drager syndrome): MR imaging. Radiology 159: 499–502.CrossRefGoogle ScholarPubMed
Vas, C. J., Parsonage, M., Lord, O. C. (1965) Parkinsonism associated with laryngeal spasm. Journal of Neurology, Neurosurgery and Psychiatry 28: 401–403.CrossRefGoogle ScholarPubMed
Wenning, G. K., Shlomo, Y. B., Magalhaes, M., Daniel, S. E., Quinn, N. P. (1994) Clinical features and natural history of multiple system atrophy. An analysis of 100 cases. Brain 117: 835–845.CrossRefGoogle ScholarPubMed
Williams, A., Hanson, D. and Calne, D. B. (1979) Vocal cord paralysis in the Shy Drager Syndrome. Journal of Neurology, Neurosurgery and Psychiatry 42: 151–153.CrossRefGoogle ScholarPubMed