Unilateral Vocal Cord Palsy as Presenting Feature of Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative pathology marked by the degeneration of upper and lower motor neurons, resulting in muscle weakness and atrophy, impairing motor function. Bulbar-onset ALS is a distinct clinical subtype, with initial involvement of bulbar motor neurons, often causing severe speech and swallowing difficulties. Despite its impact, bulbar-onset ALS, especially with rare symptoms like unilateral vocal cord palsy (UVCP), lacks extensive research. Here, we detail the case of a 79-year-old nonambulatory diabetic male with a 1-year history of hoarseness of voice, diagnosed with bulbar-onset ALS with UVCP. This underscores the importance of recognizing unusual presentations of ALS, particularly in geriatric populations, urging tailored medical evaluations for optimal care and improved outcomes in this challenging neurological condition.