Korean J Crit Care Med.  2015 May;30(2):123-127. 10.4266/kjccm.2015.30.2.123.

Multiple System Atrophy Manifested by Bilateral Vocal Cord Palsy as an Initial Sign

• Seo Y
• Jeung S
• Yoon H
• Kim MC
• Lee NK
• Ghang BZ
• Chung SJ
• Koh Y

• KMID: 2227681
• DOI: http://doi.org/10.4266/kjccm.2015.30.2.123

Abstract

A 71-year-old male initially presented with vocal cord palsy and underwent tracheostomy. After thorough examination, urogenital dysfunction, orthostatic hypotension, and Parkinsonism were found, which led to the diagnosis of multiple system atrophy (MSA). After the tracheostomy, bi-level positive airway pressure ventilation was required during the night due to nocturnal hypoxemia. Night-time hypoxemia is related to central sleep apnea, which is one of the manifestations of MSA. This is the first case of MSA manifested by bilateral vocal cord palsy as an initial sign in Korea. This case supports the notion that MSA should be taken into consideration when vocal cord paralysis is observed.

Keyword

airway obstruction; multiple system atrophy; parkinsonism; vocal cord paralysis

MeSH Terms

Aged
Airway Obstruction
Anoxia
Diagnosis
Humans
Hypotension, Orthostatic
Korea
Male
Multiple System Atrophy*
Parkinsonian Disorders
Sleep Apnea, Central
Tracheostomy
Ventilation
Vocal Cord Paralysis*

Figure

• 

  Fig. 1. Absence of movement of the vocal cords during bronchoscopy performed after tracheal intubation.

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  Fig. 2. (A) T2-weighted axial images of brain MRI shows the hypointensity and fuzzy boundaries of the dorsolateral part of the posterior putamen (white arrow). The signal intensity appears to increase around the outward edge of the putamen (black arrow). (B) Dopamine transporter positron emission tomography image (F-18 FP-CIT Brain PETCT) shows reduced numbers of dopamine transporters in the bilateral putamen.

Reference

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