Pantothenate kinase-associated neurodegeneration causing paradoxical vocal fold motion

We report a patient with paradoxical vocal fold motion (PVFM) due to pantothenate kinase-associated neurodegeneration, a rare neurodegenerative disease and a subclass of neurodegeneration with brain iron accumulation disorders. PVFM is marked by normal vocal fold anatomy and physiology with intermittent adduction during the respiratory cycle. Many etiologies have been reported and include laryngeal hypersensitivity such as asthma and gastroesophageal reflux, functional disorders, and neurologic disorders such as focal respiratory dystonia. This case highlights the occasional association of PVFM with underlying neurologic disorders, especially those that disrupt autonomic functioning.