Vocal cord abductor paralysis (VCAP) in Parkinson's disease: difference from VCAP in multiple system atrophy

Isozaki, Eiji; Shimizu, Toshio; Takamoto, Kiyomi; Horiguchi, Satoshi; Hayashida, Takumi; Oda, Masaya; Tanabe, Hitoshi

doi:10.1016/0022-510x(95)00030-6

Cited by 48 publications

(31 citation statements)

References 18 publications

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“…Since NG tube syndrome can develop in any patient under NG tube feeding, it is of importance to know the existence of NG tube syndrome and to distinguish this treatable NG tubeinduced VCAP from the neurodegenerative disorder-related VCAP (15)(16)(17)(18). However, the diagnosis of a variant form of NG tube syndrome described here was difficult, because neither postcricoid esophageal ulcer nor throat pain, which are diagnostic clues in the typical NG tube syndrome, was found.…”

Section: Discussionmentioning

confidence: 84%

A Variant Form of Nasogastric Tube Syndrome

et al. 2005

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Nasogastric tube syndrome named by Sofferman et al in 1981 is a laryngeal complication presenting with lifethreatening vocal cord abductor paralysis derived from peroforation of the NG tube-induced esophageal ulcer. As compared with the previously reported cases of this syndrome, our 4 autopsied patients were so peculiar in the following two points that vocal cord abductor paralysis developed repeatedly and no esophageal ulcer was present in spite of the presence of the laryngeal abductor muscle injury. We hypothesized that the etiology of such a variant form was circulatory injury of the laryngeal abductor muscle which was caused by the compression of the postcricoid blood vessels perfusing this muscle. Nasogastric tube syndrome, which is treatable by decannulation, cannot be ruled out even if no esophageal ulcer is detected by fiberoptic laryngoscopy.

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Section: Discussionmentioning

confidence: 84%

A Variant Form of Nasogastric Tube Syndrome

et al. 2005

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“…In contrast with frequent VCAP in MSA, VCAP is very rare in clinically diagnosed PD patients [5,8,9] has not yet been reported in clinically diagnosed DLB. Among them, autopsy-verified PD with VCAP was limited to a single report [5] . Because no remarkable changes were detected in the intrinsic laryngeal muscles of these PD patients with VCAP, sustained tonic state of intrinsic laryngeal muscles was considered to be responsible for VCAP in PD.…”

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confidence: 89%

“…In contrast with frequent VCAP in MSA, VCAP is very rare in clinically diagnosed PD patients [5,8,9] ,…”

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confidence: 99%

“…1 b). Although this pathological change extended to the ambiguus nucleus, the neuronal loss and gliosis of Dear Sir, Vocal cord abductor paralysis (VCAP), frequent in the later stage of multiple systemic atrophy (MSA) [1][2][3][4][5] , is rare in Parkinson's disease (PD) [5,8,9] and exceptional in dementia with Lewy bodies (DLB). Here we report the first autopsy-verified case of DLB with VCAP.…”

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confidence: 99%

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An Autopsy Case of Dementia with Lewy Bodies with Vocal Cord Abductor Paralysis

Toru

Uchihara²,

Hara³

et al. 2015

Eur Neurol

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cal -chest XP and CT revealed no lesion affecting the recurrent and/or vagus nerves. The family's consent to perform tracheotomy was not obtained. At the age of 89, he was admitted to our hospital with pyrexia. On admission, neurological examination revealed new findings including right-sided dominant rigidity and Myerson's sign. Resting tremor was absent. He showed severe dementia (MMSE 0/30). Moderate-tosevere atrophy of fronto-temporal cortex including hippocampus and ischemic change were revealed on his brain MRI ( fig. 1 a). But brainstem-cerebellar atrophy, hot cross ban sign or abnormal intensity of striatum were absent. On hospital day 34, he died with uncontrolled infection.Brain weight was 1,185 g. Macroscopically, the medial temporal lobe was atrophic, and moderate-to-severe depigmentation was apparent in the substantia nigra and locus ceruleus. Histologically, the brain stem (substantia nigra, locus ceruleus, dorsal motor nucleus of the vagus, raphe nuclei) was moderately to severely involved with Lewy pathology ( fig. 1 b). Although this pathological change extended to the ambiguus nucleus, the neuronal loss and gliosis of Dear Sir, Vocal cord abductor paralysis (VCAP), frequent in the later stage of multiple systemic atrophy (MSA) [1][2][3][4][5] , is rare in Parkinson's disease (PD) [5,8,9] and exceptional in dementia with Lewy bodies (DLB). Here we report the first autopsy-verified case of DLB with VCAP.The patient felt anxiety at the age of 71, and consulted the psychiatrist of our hospital; mild dementia was diagnosed and minor tranquilizer was prescribed. At the age of 75, he experienced difficulty in playing tennis. Gradually, his walking slowed down. At the age of 76, he had visual hallucination. A neurologist of our hospital noted akinesia, mask-like face and small steppage gait and apparent dementia based on mini-mental state examination (MMSE 21/30). He was diagnosed as having probable DLB based on the clinical criteria [10] . L -DOPA was administered, but his symptoms progressed gradually. He had a percutaneous endoscopic gastrostomy because of aspiration pneumonia at the age of 81. He became bedridden at the age of 83. At the age of 87, he exhibited inspiratory stridor, and endoscopic examination of the larynx disclosed bilateral VCAP. The cervi- fig. 1 c, d). Lewy pathology were also seen in the limbic system (hippocampus, amygdala, cingulate gyrus) moderately ( fig. 1 e), in the neocortex (superior temporal, insula, parietal, occipital gyri) mildly, and in the spinal cord (cervical to sacral segment) moderately. These were consistent with DLB of the neocortical type in pathological criteria [10] . Alzheimer pathology of Braak NFT stage II and amyloid stage B were also seen. There were no findings associated with old age hippocampal sclerosis. Intrinsic laryngeal muscles showed mild neurogenic change including atrophic fibers, angulated fibers, and small group atrophy ( fig. 1 f).Anatomical tracing based on autopsy samples of MSA patients from ambiguus nucleus, myelinated fibers in th...

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“…These findings indicate that obstructive sleep apnea may be not a relevant issue in PD. Nocturnal stridor caused by vocal cord abductor dysfunction can develop in patients with PD but more frequently occurs in patients with multiple system atrophy (MSA) (Isozaki et al, 1995). It is important to screen for vocal cord abductor dysfunction with a laryngoscopy during sleep when nocturnal stridor occurs.…”

Section: Sleep Apnea Syndrome (Sas)mentioning

confidence: 99%