Skip to main content
SpringerLink
Log in

Abductor Paresis in Shy–Drager Disease

  • Chapter
  • First Online:
Movement Disorder Emergencies

Part of the book series: Current Clinical Neurology ((CCNEU))

  • 1805 Accesses

Abstract

Vocal cord abductor paralysis (VCAP) is one of the life-threatening ­complications in multiple system atrophy. We proposed the mechanism as a multifactorial process, involving paralytic, nonparalytic, and enhancing factors. VCAP is diagnosed by both clinical features, including nocturnal inspiratory stridor with severe oxygen desaturation, and laryngofiberscopic examination showing paradoxical vocal cord movement. While a tracheostomy has been exclusively applied for VCAP in the past, noninvasive positive pressure ventilation has recently been used with some effectiveness. Of clinical importance is that the upper airway obstructions caused by the supraglottic tissues such as floppy epiglottis and floppy arytenoid are unresponsive to noninvasive positive pressure ventilation.

This chapter contains video segments that can be found on the accompanying DVD.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 159.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Holinger LD, Holinger PC, Holinger PH. Etiology of bilateral abductor vocal cord paralysis: a review of 389 cases. Ann Otol Rhinol Laryngol. 1976;4:428–36.

    Google Scholar 

  2. Lapresle J, Annabi A. Olivopontocerebellar atrophy with velopharyngolaryngeal paralysis: a contribution to the somatotopy of the nucleus ambiguus. J Neuropathol Exp Neurol. 1979;38:401–6.

    Article  PubMed  CAS  Google Scholar 

  3. Israel RH, Marino JM. Upper airway obstruction in the Shy-Drager syndrome. Ann Neurol. 1977;2:83.

    Article  PubMed  CAS  Google Scholar 

  4. Williams A, Hanson D, Calne DB. Vocal cord paralysis in the Shy-Dragger syndrome. J Neurol Neurosurg Psychiatry. 1979;42:151–3.

    Article  PubMed  CAS  Google Scholar 

  5. Bannister R, Gibson W, Michaels L, Oppenheimer DR. Laryngeal abductor paralysis in multiple system atrophy: a report on three necropsied cases with observations on the laryngeal muscles and the nuclei ambigui. Brain. 1981;104:351–68.

    Article  PubMed  CAS  Google Scholar 

  6. Isozaki E, Matsubara S, Hayashida T, Oda M, Hirai S. Morphometric study of nucleus ambiguus in multiple system atrophy presenting with vocal cord abductor paralysis. Clin Neuropathol. 2000;19:213–20.

    PubMed  CAS  Google Scholar 

  7. Guindi GM, Bannister R, Gibson WP, Payne JK. Laryngeal electromyography in multiple system atrophy with autonomic failure. J Neurol Neurosurg Psychiatry. 1981;44:49–53.

    Article  PubMed  CAS  Google Scholar 

  8. Hayashi M, Isozaki E, Oda M, Tanabe H, Kimura J. Loss of large myelinated nerve fibers of the recurrent laryngeal nerve in patients with multiple system atrophy and vocal cord palsy. J Neurol Neurosurg Psychiatry. 1997;62:234–8.

    Article  PubMed  CAS  Google Scholar 

  9. Benarroch EE, Schmeichel AM, Parisi JE. Preservation of branchimotor neurons of the nucleus ambiguus in multiple system atrophy. Neurology. 2003;60:115–7.

    Article  PubMed  Google Scholar 

  10. Simpson DM, Kaufmann H, Sanders I, Wolfe DE. Laryngeal dystonia in multiple system atrophy. Muscle Nerve. 1992;15:1213–5.

    PubMed  CAS  Google Scholar 

  11. Merlo LM, Occhini A, Pacchetti C, Alfonsi E. Not paralysis, but dystonia causes stridor in multiple system atrophy. Neurology. 2002;58:649–52.

    Article  PubMed  Google Scholar 

  12. Aragane N, Katoh O, Yamada H, Kuroda Y, Maeyama T. Respiratory failure due to vocal cord dyskinesia in olivo-ponto-cerebellar atrophy. Chest. 1989;96:1212–4.

    Article  PubMed  CAS  Google Scholar 

  13. Isozaki E. Clinicopathological, electromyographical, and phoniatric studies on bilateral vocal cord paralysis in multiple system atrophy. Kitakanto Med J. 1991;41:389–409.

    Article  Google Scholar 

  14. Isozaki E, Naito A, Horiguchi S, Kawamura R, Hayashida T, Tanabe H. Early diagnosis and stage classification of vocal cord abductor paralysis in patients with multiple system atrophy. J Neurol Neurosurg Psychiatry. 1996;60:399–402.

    Article  PubMed  CAS  Google Scholar 

  15. Bassetti CL, Gugger M. Sleep disordered breathing in neurologic diseases. Swiss Med Wkly. 2002;132:109–15.

    PubMed  Google Scholar 

  16. Thomas PS, Geddes DM, Barnes PJ. Pseudo-steroid resistant asthma. Thorax. 1999;54:352–6.

    Article  PubMed  CAS  Google Scholar 

  17. Isozaki E, Osanai R, Horiguchi S, Hayashida T, Hirose K, Tanabe H. Laryngeal electromyography with separated surface electrodes in patients with multiple system atrophy presenting with vocal cord paralysis. J Neurol. 1994;241:551–6.

    Article  PubMed  CAS  Google Scholar 

  18. Isono S, Shiba K, Yamaguchi M, et al. Pathogenesis of laryngeal narrowing in patients with multiple system atrophy. J Physiol. 2001;536:237–49.

    Article  PubMed  CAS  Google Scholar 

  19. Isozaki E, Shimizu T, Takamoto K, et al. Vocal cord abductor paralysis (VCAP) in Parkinson’s disease: difference from VCAP in multiple system atrophy. J Neurol Sci. 1995;130:197–202.

    Article  PubMed  CAS  Google Scholar 

  20. Wu YR, Chen CM, Ro LS, Chen ST, Tang LM. Vocal cord paralysis as an initial sign of multiple system atrophy in the central nervous system. J Formos Med Assoc. 1996;95:804–6.

    PubMed  CAS  Google Scholar 

  21. Hughes RG, Gibbin KP, Lowe J. Vocal fold abductor paralysis as a solitary and fatal manifestation of multiple system atrophy. J Laryngol Otol. 1998;112:177–8.

    PubMed  CAS  Google Scholar 

  22. Isozaki E, Miyamoto K, Osanai R, Hayashida T, Tanabe H. Clinical studies of 23 patients with multiple system atrophy presenting with vocal cord paralysis. Rinsho Shinkeigaku. 1991;31:249–54.

    PubMed  CAS  Google Scholar 

  23. Kakitsuba N, Sadaoka T, Kanai R, Fujiwara Y, Takahashi H. Peculiar snoring in patients with multiple system atrophy: its sound source, acoustic characteristics, and diagnostic significance. Ann Otol Rhinol Laryngol. 1997;106:380–4.

    PubMed  CAS  Google Scholar 

  24. Isozaki E, Hayashi M, Hayashida T, Tanabe H, Hirai S. Vocal cord abductor paralysis in multiple system atrophy—paradoxical movement of vocal cords during sleep. Rinsho Shinkeigaku. 1996;36:529–33.

    PubMed  CAS  Google Scholar 

  25. Miyazaki S, Itasaka Y, Ishikawa K, Tagawa K. Acoustic analysis of snoring and the site of airway obstruction in sleep related respiratory disorders. Acta Otolaryngol Suppl. 1998;537:47–51.

    Article  PubMed  CAS  Google Scholar 

  26. Merite Drancy A, Laccourreye O, Brasnu D, Laccourreye H. Partial posterior cordectomy with laser CO2 in bilateral recurrent paralysis. Ann Otolaryngol Chir Cervicofac. 1992;109:235–9.

    PubMed  CAS  Google Scholar 

  27. Ptok M, Schonweiler R. Botulinum toxin type A-induced “rebalancing” in bilateral vocal cord paralysis? HNO. 2001;49:548–52.

    Article  PubMed  CAS  Google Scholar 

  28. Umeno H, Ueda Y, Mori K, Chijiwa K, Nakashima T, Kotby NM. Management of impaired vocal fold movement during sleep in a patient with Shy-Drager syndrome. Am J Otolaryngol. 2000;21:344–8.

    Article  PubMed  CAS  Google Scholar 

  29. Kenyon GS, Apps MCP, Traub M. Stridor and obstructive sleep apnea in Shy-Drager syndrome treated by laryngofissure and cord lateralization. Laryngoscope. 1984;94:1106–8.

    Article  PubMed  CAS  Google Scholar 

  30. Iranzo A, Santamaria J, Toloza E. Continuous positive air pressure eliminates nocturnal stridor in multiple system atrophy. Lancet. 2000;356:1329–30.

    Article  PubMed  CAS  Google Scholar 

  31. Miyamoto M, Miyamoto T, Katayama S, Hirata K. Effective nasal CPAP therapy for heavy snoring and paradoxical respiration during sleep in a case of multiple system atrophy. Rinsho Shinkeigaku. 1998;38:1059–63.

    PubMed  CAS  Google Scholar 

  32. Andersen APD, Alving J, Lildholdt T, Wulff CH. Obstructive sleep apnea initiated by a lax epiglottis A contraindication for continuous positive airway pressure. Chest. 1987;91:621–3.

    Article  PubMed  CAS  Google Scholar 

  33. Silva DA, Sanders I. Continuous positive airway pressure as a promoter of laryngospasm during halothane anesthesia. Ann Otol Rhinol Laryngol. 1992;101:893–6.

    PubMed  CAS  Google Scholar 

  34. Shiomi T, Guilleminault C, Sasanabe R, et al. Primary pulmonary hypertension with central sleep apnea—sudden death after bilevel positive airway pressure. Jpn Cir J. 2000;64:723–6.

    Article  CAS  Google Scholar 

  35. Isozaki E. Upper airway obstruction in multiple system atrophy. Shinkei Kenkyu no Shinpo. 2006;50:409–19.

    Google Scholar 

  36. Isozaki E, Tobisawa S, Nishizawa M, Nakayama H, Fukui K, Takanishi A. Experimental vocal cord abduction impairments with an artificial vocal cord. Rinsho Shinkeigaku. 2009;49:407–13.

    Article  PubMed  Google Scholar 

  37. Silber MH, Levine S. Stridor and death in multiple system atrophy. Mov Disord. 2000;15:699–704.

    Article  PubMed  CAS  Google Scholar 

  38. Gueye PN, Lofaso F, Borron SW, et al. Mechanism of respiratory insufficiency in pure or mixed drug-induced coma involving benzodiazepines. J Toxicol Clin Toxicol. 2002;40:35–47.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Tokyo Metropolitan Institute for Neuroscience, 2-6 Musashidai, Fuchu, Tokyo, 183-8526, Japan

    Eiji Isozaki M.D.

  2. Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan

    Eiji Isozaki M.D.

Authors
  1. Eiji Isozaki M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eiji Isozaki M.D. .

Editor information

Editors and Affiliations

  1. , Neurology, Columbia University Medical Center, West 168th St. Suite 310 710, New York, 10032, USA

    Steven J. Frucht

Electronic Supplementary Material

Movement_Disorders_Emergencies_C7.mov (84,654) KB

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Isozaki, E. (2013). Abductor Paresis in Shy–Drager Disease. In: Frucht, S. (eds) Movement Disorder Emergencies. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-835-5_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-835-5_7

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60761-834-8

  • Online ISBN: 978-1-60761-835-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation