Yokoji I, Nakamura S, Ikeda T
Department of Internal Medicine Tsuruga City Hospital.
Rinsho Shinkeigaku. 1997 Jun;37(6):523-5.
We report a 65-year-old male with progressive supranuclear palsy (PSP) who developed bilateral vocal cord abductor paralysis (VCAP). The patient was admitted to our hospital because of impaired gait. He was well until two years earlier, when he began to walk unsteadily. During the next two years, dysarthria and dysphagia developed and his gait worsened gradually. On admission, neurological examination showed impaired vertical and incomplete lateral gaze. His speech was slow and monotonous. Contractures were found in the neck muscles and elbows. The deep tendon reflexes were increased in the upper and decreased in the lower extremities. Babinski sign was negative. Snout and forced grasping reflexes were elicited. He showed marked bradykinesia. Magnetic resonance imaging revealed a midbrain tectum atrophy. Single photon emission tomography showed severe hypoper-fusion in the frontal cortex. No improvement was provided by the administration of levodopa-carbidopa, bromocriptine, droxydopa and amitriptyline. One month after admission, inspiratory stridor developed at night. The laryngofiberscopic examination demonstrated VCAP. An emergency tracheostomy relieved his respiratory distress. Although VCAP rarely occurs in neurodegenerative disorders other than multiple system atrophy, attention to VCAP should be required in PSP patients.
我们报告一例65岁患有进行性核上性麻痹（PSP）的男性患者，其出现了双侧声带外展麻痹（VCAP）。该患者因步态障碍入住我院。他在两年前身体状况良好，之后开始走路不稳。在接下来的两年里，出现了构音障碍和吞咽困难，且步态逐渐恶化。入院时，神经系统检查显示垂直凝视受损和不完全性侧方凝视。他的言语缓慢且单调。在颈部肌肉和肘部发现了挛缩。上肢的深腱反射增强，下肢的深腱反射减弱。巴宾斯基征阴性。引出了噘嘴反射和强握反射。他表现出明显的运动迟缓。磁共振成像显示中脑顶盖萎缩。单光子发射断层扫描显示额叶皮质严重灌注不足。给予左旋多巴 - 卡比多巴、溴隐亭、屈昔多巴和阿米替林均无改善。入院一个月后，夜间出现吸气性喘鸣。喉镜检查显示为VCAP。紧急气管切开术缓解了他的呼吸窘迫。尽管VCAP很少发生在多系统萎缩以外的神经退行性疾病中，但PSP患者应注意VCAP。
