Vocal cord abductor paralysis in multiple system atrophy: a case report

Area of Science:

• Neurology
• Neurodegenerative Diseases
• Sleep Medicine

Background:

• Multiple system atrophy (MSA) is a progressive neurodegenerative disorder affecting motor control, autonomic function, and coordination.
• Vocal cord abductor paralysis (VCAP) is a critical complication of MSA, often indicating a poor prognosis and risk of sudden nocturnal death.

Observation:

• A case report details a patient initially treated for Parkinson's disease presenting with dizziness and sleep apnea.
• Fiberoptic laryngoscopy identified VCAP as a potential cause of the patient's sleep apnea.
• The patient exhibited severely impaired optokinetic nystagmus and absent caloric test responses, indicative of neuro-otological dysfunction.

Findings:

• VCAP, typically seen in advanced MSA stages, was identified in this patient potentially earlier than usual.
• Abnormal neuro-otological findings, including VCAP, were crucial in diagnosing MSA.

Implications:

• This case highlights the importance of considering VCAP in patients with unexplained sleep apnea, especially those with parkinsonian symptoms.
• Early diagnosis of MSA through objective findings like VCAP can lead to timely management and potentially improve patient outcomes.
• Recognizing VCAP as an early sign in MSA may facilitate earlier intervention and management strategies for this debilitating disease.