Nelke Christopher, Labeit Bendix, Meuth Sven G, Warnecke Tobias, Dziewas Rainer, Ruck Tobias
Clinic of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany.
Front Neurol. 2020 Oct 15;11:581060. doi: 10.3389/fneur.2020.581060. eCollection 2020.
To prevent severe and potentially life-threatening consequences of bilateral vocal fold paralysis (BVFP), the identification and management of reversible causes is pivotal. Myasthenia gravis (MG) presenting with BVFP is rarely reported and remains incompletely understood. Although symptom control is achievable for most MG patients with sufficient therapy, atypical clinical presentation such as BVFP might preclude diagnosis and thus effective treatment. Here, we present a case of BVFP as leading manifestation of MG successfully treated with plasmapheresis. Moreover, we performed a literature review of the few existing cases reported between 1980 and 2020 indicating that elderly patients are particularly at risk for MG presenting with severe BVFP and that edrophonium testing with fiber optic endoscopic evaluation of swallowing (FEES) might be valuable for establishing the diagnosis. We conclude that clinicians should consider MG as possible and reversible cause for BVFP.
为预防双侧声带麻痹（BVFP）的严重及潜在危及生命的后果，识别和处理可逆性病因至关重要。以BVFP为表现的重症肌无力（MG）鲜有报道，且仍未被完全理解。尽管大多数MG患者通过充分治疗可实现症状控制，但诸如BVFP等非典型临床表现可能会妨碍诊断，进而影响有效治疗。在此，我们报告一例以BVFP为主要表现的MG患者，经血浆置换成功治疗。此外，我们对1980年至2020年间报道的少数现有病例进行了文献综述，表明老年患者尤其易患伴有严重BVFP的MG，且依酚氯铵试验联合纤维内镜吞咽功能评估（FEES）可能对确诊有价值。我们得出结论，临床医生应将MG视为BVFP可能的可逆性病因。
