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Early diagnosis and stage classification of vocal cord abductor paralysis in patients with multiple system atrophy.
J Neurol Neurosurg Psychiatry. 1996 Apr; 60(4):399-402.JN

Abstract

OBJECTIVES

Vocal cord abductor paralysis (VCAP) is a life threatening complication which may cause nocturnal sudden death in patients with multiple system atrophy. However, the early diagnosis of VCAP is often difficult to make on routine laryngoscopy performed during wakefulness, as stridor, which is the sole symptom of VCAP in the early stage, develops only during sleep. The aim was to investigate laryngeal dysfunction in patients with multiple system atrophy while awake and asleep.

METHODS

Seven patients with multiple system atrophy with nocturnal stridor and five control patients were studied. Vocal cord movement was analysed by laryngoscopy while the patients were awake and also during sleep induced by intravenous diazepam.

RESULTS

When awake, for the seven patients with multiple system atrophy normal movement of the vocal cords occurred in three, mild abduction restriction in three, and paradoxical movement in one. When asleep, however, all showed obvious paradoxical movement with high pitched inspiratory stridor. In controls, there were no differences in the vocal cord movement between wakefulness and sleep. From these findings, VCAP could be divided into four stages: stage 0 (normal) with normal vocal cord movement during both wakefulness and sleep, stage 1 (mild VCAP) with normal movement during wakefulness and paradoxical movement during sleep, stage 2 (moderately severe VCAP) with abduction restriction during wakefulness and paradoxical movement during sleep, and stage 3 (severe VCAP) with an almost midline position for the vocal cords during both wakefulness and sleep.

CONCLUSIONS

Laryngoscopy during sleep can disclose subclinical VCAP, making an early diagnosis of VCAP in patients with multiple system atrophy. Stage 2 of VCAP seems to be a suitable stage for tracheostomy in patients with multiple system atrophy.

Authors+Show Affiliations

Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

8774404

Citation

Isozaki, E, et al. "Early Diagnosis and Stage Classification of Vocal Cord Abductor Paralysis in Patients With Multiple System Atrophy." Journal of Neurology, Neurosurgery, and Psychiatry, vol. 60, no. 4, 1996, pp. 399-402.
Isozaki E, Naito A, Horiguchi S, et al. Early diagnosis and stage classification of vocal cord abductor paralysis in patients with multiple system atrophy. J Neurol Neurosurg Psychiatry. 1996;60(4):399-402.
Isozaki, E., Naito, A., Horiguchi, S., Kawamura, R., Hayashida, T., & Tanabe, H. (1996). Early diagnosis and stage classification of vocal cord abductor paralysis in patients with multiple system atrophy. Journal of Neurology, Neurosurgery, and Psychiatry, 60(4), 399-402.
Isozaki E, et al. Early Diagnosis and Stage Classification of Vocal Cord Abductor Paralysis in Patients With Multiple System Atrophy. J Neurol Neurosurg Psychiatry. 1996;60(4):399-402. PubMed PMID: 8774404.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early diagnosis and stage classification of vocal cord abductor paralysis in patients with multiple system atrophy. AU - Isozaki,E, AU - Naito,A, AU - Horiguchi,S, AU - Kawamura,R, AU - Hayashida,T, AU - Tanabe,H, PY - 1996/4/1/pubmed PY - 1996/4/1/medline PY - 1996/4/1/entrez SP - 399 EP - 402 JF - Journal of neurology, neurosurgery, and psychiatry JO - J. Neurol. Neurosurg. Psychiatry VL - 60 IS - 4 N2 - OBJECTIVES: Vocal cord abductor paralysis (VCAP) is a life threatening complication which may cause nocturnal sudden death in patients with multiple system atrophy. However, the early diagnosis of VCAP is often difficult to make on routine laryngoscopy performed during wakefulness, as stridor, which is the sole symptom of VCAP in the early stage, develops only during sleep. The aim was to investigate laryngeal dysfunction in patients with multiple system atrophy while awake and asleep. METHODS: Seven patients with multiple system atrophy with nocturnal stridor and five control patients were studied. Vocal cord movement was analysed by laryngoscopy while the patients were awake and also during sleep induced by intravenous diazepam. RESULTS: When awake, for the seven patients with multiple system atrophy normal movement of the vocal cords occurred in three, mild abduction restriction in three, and paradoxical movement in one. When asleep, however, all showed obvious paradoxical movement with high pitched inspiratory stridor. In controls, there were no differences in the vocal cord movement between wakefulness and sleep. From these findings, VCAP could be divided into four stages: stage 0 (normal) with normal vocal cord movement during both wakefulness and sleep, stage 1 (mild VCAP) with normal movement during wakefulness and paradoxical movement during sleep, stage 2 (moderately severe VCAP) with abduction restriction during wakefulness and paradoxical movement during sleep, and stage 3 (severe VCAP) with an almost midline position for the vocal cords during both wakefulness and sleep. CONCLUSIONS: Laryngoscopy during sleep can disclose subclinical VCAP, making an early diagnosis of VCAP in patients with multiple system atrophy. Stage 2 of VCAP seems to be a suitable stage for tracheostomy in patients with multiple system atrophy. SN - 0022-3050 UR - https://www.unboundmedicine.com/medline/citation/8774404/Early_diagnosis_and_stage_classification_of_vocal_cord_abductor_paralysis_in_patients_with_multiple_system_atrophy_ L2 - http://jnnp.bmj.com/cgi/pmidlookup?view=long&pmid=8774404 DB - PRIME DP - Unbound Medicine ER -