2023 Volume 60 Issue 3 Pages 138-142
Laryngeal stridor and obstructive sleep apnea due to paradoxical adduction of the vocal cords during inspiration in multiple system atrophy are well known, but laryngospasm has received less attention. We report the case of a 71-year-old man with multiple system atrophy who suffered sudden respiratory failure due to laryngospasm. At the age of 68, he developed a gait disturbance and visited our department. He presented cerebellar ataxia and orthostatic hypotension, and brain MRI showed cerebellar and pontine atrophy. He was diagnosed with multiple system atrophy. His condition progressed slowly. At the age of 71, he suddenly suffered breathing difficulty without any triggers during the daytime, became unconscious, and was taken by ambulance to our hospital. He presented laryngeal stridor and hoarseness. Chest CT revealed infiltrates in the left lower lung field. He was diagnosed as having aspiration pneumonia and treated with antibiotics. Laryngoscopy showed fixed vocal cords at the paramedian, and the sudden respiratory insufficiency and laryngeal stridor were considered to have been caused by laryngospasm. One week after admission, the laryngeal stridor disappeared. We subsequently confirmed that the hoarseness had disappeared. Paradoxical contraction of the vocal cord adduction muscle is seen both in laryngeal spasm and stridor in multiple system atrophy, and these conditions may involve an exaggerated laryngeal adductor reflex associated with neurodegeneration in multiple system atrophy.
