Wu Tara J, Lewis Sean M, Woo Peak
1 Department of Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
2 Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Ann Otol Rhinol Laryngol. 2019 Feb;128(2):157-161. doi: 10.1177/0003489418808814. Epub 2018 Oct 26.
: The presentation, course, and management of a rare laryngeal manifestation of neurosarcoidosis due to central nervous system (as opposed to peripheral nervous system) injury are described.
: The authors present 3 cases of vocal cord paralysis as the initial symptom of isolated neurosarcoidosis at a tertiary care laryngology clinic.
: Laryngoscopy diagnosed unilateral vocal cord paralysis. Laryngeal electromyography revealed high vagal injury, prompting workup on brain magnetic resonance imaging. On magnetic resonance imaging, 2 cases showed basilar leptomeningeal inflammation and 1 case showed a brainstem mass. Patients were found at follow-up to have severe, progressive vagal injury, with patients developing severe quality of life impairments and medical complications.
: Neurosarcoidosis is not usually considered in the differential diagnosis of vocal cord paralysis. At initial presentation, all patients lacked other cranial neuropathies and systemic sarcoidosis manifestations, making diagnosis difficult. Otolaryngologists should be aware of this rare presentation, as prompt diagnosis by brain magnetic resonance imaging with or without central nervous system biopsy, as opposed to traditional chest radiography or computed tomography for the workup of peripheral nerve injury, is necessary. Serial laryngeal examinations are recommended for close monitoring of progressive disease and recommending treatment. Injection or medialization laryngoplasty can provide improvements in voicing but not swallow.
本文描述了因中枢神经系统（与周围神经系统相对）损伤导致的神经结节病罕见喉部表现的临床表现、病程及治疗。
作者在一家三级护理喉科诊所介绍了3例以声带麻痹为孤立性神经结节病初始症状的病例。
喉镜检查诊断为单侧声带麻痹。喉肌电图显示迷走神经高位损伤，促使进行脑磁共振成像检查。在磁共振成像上，2例显示基底池软脑膜炎症，1例显示脑干肿块。随访发现患者有严重的、进行性迷走神经损伤，生活质量严重受损并出现医学并发症。
声带麻痹的鉴别诊断通常不考虑神经结节病。初次就诊时，所有患者均无其他颅神经病变和系统性结节病表现，诊断困难。耳鼻喉科医生应了解这种罕见表现，因为与传统的胸部X线摄影或计算机断层扫描用于周围神经损伤检查不同，通过脑磁共振成像进行快速诊断（无论是否进行中枢神经系统活检）是必要的。建议进行系列喉部检查以密切监测疾病进展并推荐治疗。注射或喉内移植物成形术可改善发声，但不能改善吞咽。
