1/16. myotonic dystrophy type 1 (DM1) presenting with laryngeal stridor and vocal fold paresis.myotonic dystrophy type 1 (DM1) is the most common inherited muscle disorder and may present in numerous ways due to characteristic multisystem involvement. We report a 47-year-old man who presented with an 8-year history of slowly progressive dyspnea and episodic stridor. The laryngeal paresis was documented with videostroboscopy and laryngeal electromyography, and treated with tracheostomy and antimyotonia agents.- - - - - - - - - - ranking = 1keywords = paresis, muscle (Clic here for more details about this article) |
2/16. Respiratory failure due to vocal cord paresis in myasthenia gravis.This report describes a female patient with myasthenia gravis who developed respiratory failure due to vocal cord paresis. The diagnosis was delayed due to the absence of other myasthenic symptoms (e.g. ptosis, muscle weakness and dysphagia). On direct laryngoscopy, her vocal cords were seen to be in the paramedian position and to move apart after the intravenous injection of edrophonium. The patient initially presented with ocular myasthenia and later returned with isolated respiratory failure. A review of the pertinent literature revealed few reports on myasthenia gravis presenting in this manner.- - - - - - - - - - ranking = 1keywords = paresis, muscle (Clic here for more details about this article) |
3/16. Bilateral vocal fold paresis and multiple system atrophy.OBJECTIVE: To review a case series of patients with systemic neurodegenerative disease presenting to a laryngologist for workup of dysphonia and found to have bilateral vocal fold paresis. DESIGN: Case series. SETTING: Tertiary care voice center. patients: Series of patients with neurodegenerative disorders examined for dysphonia. MAIN OUTCOME MEASURES: history and physical examination including fiberoptic laryngoscopy were performed on all patients. Some patients underwent polysomnography. RESULTS: Seven patients during a 2-year period were noted to have bilateral abductor vocal fold paresis. Five of 7 (71%) had the diagnosis of multiple system atrophy proposed by the laryngologist. All 7 patients described sleep-disordered breathing with stridor. CONCLUSIONS: patients with systemic neurodegenerative disorders such as parkinson disease should be examined for multiple system atrophy and for evidence of bilateral vocal fold paresis. Workup for stridor should include polysomnography. Treatment of glottic obstruction in these patients includes constant positive airway pressure at night or tracheotomy. The finding of bilateral vocal fold paresis can be life threatening.- - - - - - - - - - ranking = 1.5990613202829keywords = paresis (Clic here for more details about this article) |
4/16. Anticholinergic agents for the treatment of "death rattle" in patients with myasthenia gravis.Difficulty clearing upper airway secretions (death rattle) is a frequent problem at the end of life. Treatment often includes the use of anticholinergic drugs. myasthenia gravis is a disease characterized by muscle weakness and fatigue caused by an immune-mediated deficiency of acetylcholine receptors at the neuromuscular junction, and it is treated with anticholinesterase agents. We report the case of a patient dying of myasthenia gravis who had problems with the "death rattle" and who presented a dilemma as to whether the use of anticholinergics would be helpful or would cause deterioration of her myasthenia. This is accompanied by a review of the relevant literature.- - - - - - - - - - ranking = 0.00058667482316633keywords = muscle (Clic here for more details about this article) |
5/16. Respiratory distress after intrathecal baclofen withdrawal.We present the case of a 19-yr-old woman with a history of generalized dystonia who developed sudden onset of adductor spasms of the vocal cords and increased dystonia after the interruption or intrathecal baclofen therapy. Her symptoms resolved after intrathecal baclofen was restored. In patients with dystonia receiving intrathecal baclofen therapy, the onset of dyspnea associated with increased muscle tone should prompt the investigation of baclofen withdrawal.- - - - - - - - - - ranking = 0.00058667482316633keywords = muscle (Clic here for more details about this article) |
6/16. Report of an obstructive goiter and its surgical treatment during delivery.We report a case of a morbidly obese young woman in her third trimester of pregnancy presenting with a history of goiter and respiratory disease. The recent history of this patient was significant for worsening respiratory symptoms over a period of 2 weeks, and, on presentation at 36 weeks gestation, she was stridorous, dyspneic at rest, and had a hoarse voice. Evaluation revealed a morbidly obese individual with a large goiter. She was biochemically euthyroid. Fiberoptic laryngoscopy revealed a left true vocal cord paresis, and ultrasound evaluation was significant for diffuse multinodular enlargement, with each lobe measuring greater than 10 cm and the isthmus measuring 5. Pulmonary function testing revealed a significant degree of upper airway obstruction without significant lower airway disease. Given the patient's clinical signs and symptoms, her tenuous airway, poor candidacy for urgent tracheotomy, and her proximity to delivery, it was agreed that the patient should undergo elective cesarean section and at its completion undergo subtotal thyroidectomy for the obstructive goiter.- - - - - - - - - - ranking = 0.19988266503537keywords = paresis (Clic here for more details about this article) |
7/16. Total airway obstruction during local anesthesia in a non-sedated patient with a compromised airway.PURPOSE: To report a case of complete upper airway obstruction after topicalization with lidocaine in a completely conscious patient with partial upper airway obstruction. CLINICAL FEATURES: A 69-yr-old man with a history of neck cancer and radiation presented for resection of recurrent neck tumour. No preoperative sedation was given. He had inspiratory and expiratory stridor but had no history of aspiration or swallowing problem. phonation was distorted but effective. The surgeon was reluctant to perform an awake tracheostomy under local anesthesia. In preparation for a fibrescope-assisted orotracheal intubation, the non-sedated patient was given topical upper airway lidocaine during which he developed total airway obstruction and hypoxemia. He was immediately intubated with a fibrescope. His vocal cords were not edematous although the supraglottic structures appeared to be. The vocal cords were abducted and their movement was limited and not paradoxical. Tumour resection was uneventful upon successful tracheal intubation and general anesthesia. tracheostomy at the end of the case was difficult, as expected. The patient tolerated the procedures and regained consciousness with no neurologic sequelae. CONCLUSION: Dynamic airflow limitation associated with local anesthesia of the upper airway may lead to complete upper airway obstruction in a compromised airway. The main cause may be the loss of upper airway muscle tone, exacerbated by deep inspiration during panic.- - - - - - - - - - ranking = 0.00058667482316633keywords = muscle (Clic here for more details about this article) |
8/16. Hereditary motor and sensor neuropathy: a cause of acute stridor.We present an acute stridor secondary to bilateral vocal cord paresis in a patient with demyelinating form (type I) of hereditary motor and sensory neuropathy (HMSN). Management problems are discussed and HMSN reviewed.- - - - - - - - - - ranking = 0.19988266503537keywords = paresis (Clic here for more details about this article) |
9/16. Nocturnal stridor in olivopontocerebellar atrophy.We describe a patient with olivopontocerebellar atrophy (OPCA) who was referred for alleged "snoring." Polysomnogram with video and audio monitoring revealed that the patient actually had nocturnal stridor causing repetitive oxygen desaturations. Direct laryngoscopy while awake showed a unilateral vocal cord paralysis. The nocturnal stridor persisted after unilateral vocal cord pinning, suggesting that the patient had probably been experiencing bilateral vocal cord paresis while asleep. We conclude that state-dependent vocal cord dysfunction may be severe in OPCA and related multiple system atrophy. Nocturnal stridor has many causes and may mimic snoring and obstructive sleep apnea syndrome. polysomnography with audio and video recordings are necessary to make the diagnosis.- - - - - - - - - - ranking = 0.19988266503537keywords = paresis (Clic here for more details about this article) |
10/16. Central vocal cord paralysis and paresis presenting as laryngeal stridor in children.vocal cord paralysis or paresis as the initial presenting symptom for intracranial tumors in children are rare. Recently, two pediatric patients who were later diagnosed as having intracranial tumors presented with the symptom of voice changes and stridor. Telescopic examination revealed bilateral vocal cord paresis and paralysis as demonstrated by video recordings. The majority of pediatric brain tumors present with both generalized and localized complaints; however, by discussing these two rare cases, we hope to underscore the importance of a thorough workup of the paralyzed or paretic vocal cords.- - - - - - - - - - ranking = 1.1992959902122keywords = paresis (Clic here for more details about this article) |
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