Isozaki E, Shimizu T, Takamoto K, Horiguchi S, Hayashida T, Oda M, Tanabe H
Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan.
J Neurol Sci. 1995 Jun;130(2):197-202. doi: 10.1016/0022-510x(95)00030-6.
Vocal cord abductor paralysis (VCAP) is rare in Parkinson's disease (PD), while it is frequent in multiple system atrophy (MSA). Although VCAP is a life-threatening complication it has not yet been clarified whether there is any difference in the mechanism of VCAP between PD and MSA. Examining 3 autopsy-proven PD patients who developed severe VCAP requiring tracheostomy, we found the following differences in the mechanism of VCAP between MSA and PD: (1) clinical and laryngofiberscopic examination showed that VCAP in PD was not exacerbated during sleep, unlike in MSA; (2) On histological examination of the intrinsic laryngeal muscles, the posterior cricoarytenoid muscle demonstrated no abnormalities in PD, while the muscle showed characteristic neurogenic atrophy in MSA. There seemed to be two types of VCAP, namely the nonparalytic type observed in PD, and the paralytic type observed in MSA. Severe dysphagia requiring tube-feeding was common among PD patients who presented with VCAP. Although the relationship between VCAP and dysphagia is unknown, one should be aware of the possibility of fatal VCAP in PD patients with severe dysphagia.
声带外展肌麻痹（VCAP）在帕金森病（PD）中较为罕见，而在多系统萎缩（MSA）中较为常见。尽管VCAP是一种危及生命的并发症，但PD和MSA之间VCAP的机制是否存在差异尚未明确。通过检查3例经尸检证实患有严重VCAP且需要气管切开术的PD患者，我们发现MSA和PD之间VCAP机制存在以下差异：（1）临床和喉镜检查显示，与MSA不同，PD患者的VCAP在睡眠期间不会加重；（2）对喉内肌进行组织学检查时，PD患者的环杓后肌未显示异常，而MSA患者的该肌肉表现出典型的神经源性萎缩。VCAP似乎有两种类型，即PD中观察到的非麻痹型和MSA中观察到的麻痹型。出现VCAP的PD患者中，严重吞咽困难需要鼻饲的情况很常见。尽管VCAP与吞咽困难之间的关系尚不清楚，但对于有严重吞咽困难的PD患者，应意识到致命VCAP的可能性。
