Vincristine‐induced laryngeal nerve paralysis

Abstract

The neurotoxicity of the Vinca alkaloids vincristine and vinblastine is well recognized. Less recognized is laryngeal nerve paralysis induced by these chemotherapeutic agents. This potentially dangerous paralysis is usually reversible when the drug is withdrawn, but other causes of hoarseness in a cancer patient must be considered. I add two cases to 19 previously documented.

Compound motor action potential duration and latency are markers of recurrent laryngeal nerve injury

“…Progressive nerve injury can increase the physiologic dispersion when select axon conduction velocities are diminished. Chemotherapy agents associated with polyneuropathy or demyelinating neuropathies can induce significant changes to the myelin architecture. If this type of injury is clinically suspected, CMAP duration could be used to make serial assessments.…”

“…35 Progressive nerve injury can increase the physiologic dispersion when select axon conduction velocities are diminished. Chemotherapy agents associated with polyneuropathy [36][37][38] or demyelinating ROC curve for CMAP duration with an AUC 5 0.78 (95% CI 0.60 to 0.96, P 5 0.03). (B) ROC curve for CMAP latency produced better discrimination between the baseline and injured RLN with an AUC 5 0.98 (95% CI 0.92 to 1.00, P < 0.001).…”

Myasthenia gravis mimicking unilateral vocal fold paralysis at presentation

“…Diabetes mellitus can cause mononeuritis, as can some pharmaceutical agents. 13 Mono-or polyneuropathies of the cranial nerves can also occur in acute herpes-varicella-zoster or herpes simplex infections. 14,15 Multiple sclerosis has also been known to cause unilateral laryngeal immobility.…”

Transient Vocal Fold Immobility

“…9 This is usually not seen until after peripheral or autonomie neural dysfunction occurs. A number of cases of reversible VFI have been reported in children and adults.…”