Laryngeal dystonia in the course of multiple system atrophy: a cause of postoperative respiratory insufficiency

Abstract

Multiple system atrophy (MSA) is an adult onset, incurable neurodegenerative disease, characterized by symptoms of nervous system failure. Occurrence of laryngeal dystonia indicates increased risk of sudden death caused by airway occlusion. We present the case report of 63-year-old patient with history of orthostatic hypotension, parkinsonism, progressive adynamia, and stridor. The patient was admitted to the hospital for diagnosis of orthostatic hypotension. A diagnosis of possible MSA was made. Because of patient’s complaints, an X-ray of the hip joint was taken. It revealed femoral neck fracture. Endoprosthesis insertion under general anesthesia was performed. Two days later the patient presented progressive adynamy and respiratory insufficiency. Endotracheal intubation and respiratory support were required followed by extubation and one more intubation. After second extubation, stridor and acute respiratory insufficiency occurred. Urgent tracheostomy was performed. After 13 days in ICU, the patient was discharged to the rehabilitation center.

Asphyxia due to laryngeal spasm as a severe complication of awake deep brain stimulation for Parkinson’s disease: a case report

“…Both conditions were associated with PD and other neurological conditions, such as multiple system atrophy, and can subsequently lead to upper airway obstruction [7]. …”

Anesthetic management of a patient with severe neck dystonia during MRI

“…Multiple system atrophy (MSA) is a heterogeneous neurodegenerative disease of the central and autonomic nervous system and is categorized into MSA with the predominant parkinsonism and MSA with predominant cerebellar ataxia (MSA-C). [ 1 ] These patients often present with neck ante flexion and sleep-related breathing disturbances which make both lying supine for long periods and deep sedation difficult.…”