Noda K, Isozaki E, Miyamoto K, Nagashima T, Tanabe H
Department of Neurology, Tokyo Metropolitan Neurological Hospital.
Rinsho Shinkeigaku. 1992 Mar;32(3):324-6.
We have reported a 50-year-old woman with HTLV-I associated myelopathy (HAM) who had bilateral abductor vocal cord paralysis. The symptoms and signs were slowly progressive spastic paraplegia, dysuria, inspiratory stridor, and snoring during sleep. She had no hoarseness. Titers of anti-HTLV-I antibody were elevated in both the serum and cerebrospinal fluid. FEV1.0% on the spirogram was reduced to 66%. The fiberscopic examination demonstrated the abductor limitation of the vocal cords during the inspiratory phase. During induced sleep after the intravenous administration of thiopental sodium, this abductor paralysis was worsened, producing a high pitched inspiratory stridor. The adduction was not disturbed at all. Needle electromyogram of the posterior crico-arytenoid muscle which is a sole abductor muscle revealed the high amplitude up to approximately 1.0 mV (normal less than 0.8 mV) with poor interference pattern, indicating neurogenic changes. After 2 months course of prednisolone (60 mg/alternative day), FEV1.0% was recovered to be 92% with the improvement of the gait disturbance, which suggests the abductor vocal cord paralysis is related to HAM. The abductor vocal cord paralysis in HAM would require a careful follow-up observation to protect the respiratory failure in the advanced stage.
我们报告了一名50岁患有人类嗜T淋巴细胞病毒I型相关脊髓病（HAM）的女性，她出现双侧声带外展麻痹。症状和体征包括缓慢进展的痉挛性截瘫、排尿困难、吸气性喘鸣以及睡眠时打鼾。她没有声音嘶哑。血清和脑脊液中抗人类嗜T淋巴细胞病毒I型抗体滴度均升高。肺功能图上的第1秒用力呼气容积百分比（FEV1.0%）降至66%。纤维喉镜检查显示吸气期声带外展受限。静脉注射硫喷妥钠诱导睡眠期间，这种外展麻痹加重，产生高调吸气性喘鸣。内收完全不受影响。作为唯一外展肌的环杓后肌针电极肌电图显示高波幅达约1.0 mV（正常小于0.8 mV），干扰图形差，提示神经源性改变。经过2个月的泼尼松龙（60 mg/隔日）疗程后，FEV1.0%恢复到92%，步态障碍改善，这表明声带外展麻痹与HAM有关。HAM中的声带外展麻痹需要仔细的随访观察，以防止晚期呼吸衰竭。
