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Tisavipat N, Chang BK, Ali F, Pittock SJ, Kammeyer R, Declusin A, Cohn SJ, Flanagan EP. Subacute Horizontal Diplopia, Jaw Dystonia, and Laryngospasm. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200128. [PMID: 37311643 DOI: 10.1212/nxi.0000000000200128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/06/2023] [Indexed: 06/15/2023]
Abstract
Jaw dystonia and laryngospasm in the context of subacute brainstem dysfunction have been described in a small number of diseases, including antineuronal nuclear antibody type 2 (ANNA-2, also known as anti-Ri) paraneoplastic neurologic syndrome. Severe episodes of laryngospasms causing cyanosis are potentially fatal. Jaw dystonia can also cause eating difficulty, resulting in severe weight loss and malnutrition. In this report, we highlight the multidisciplinary management of this syndrome associated with ANNA-2/anti-Ri paraneoplastic neurologic syndrome and discuss its pathogenesis.
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Affiliation(s)
- Nanthaya Tisavipat
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Bryce K Chang
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Farwa Ali
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Sean J Pittock
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Ryan Kammeyer
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Anthony Declusin
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Samuel J Cohn
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Eoin P Flanagan
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO.
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Avila MJ, Aguilar-Salinas P, Burket AR, Dumont TM. Parkinson Disease, Dysphagia, and Cervical Spine Surgery. Clin Spine Surg 2022; 35:E26-E30. [PMID: 34029260 DOI: 10.1097/bsd.0000000000001197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN An analysis of a National Database. OBJECTIVE The objective of this study was to evaluate the rate of dysphagia for Parkinson disease (PD) patients undergoing cervical spine surgery for cervical myelopathy. SUMMARY OF BACKGROUND DATA Cervical spondylotic myelopathy (CSM) is an increasingly common problem in the aging population. Several surgical options exist to treat this condition including anterior, posterior and combined surgical approaches. Each approach carries its own set of postoperative complications. Little is known of the of outcomes after cervical spine surgery in PD. MATERIALS AND METHODS The National Inpatient sample was queried 1998 to 2016, all elective admissions with CSM were identified. Surgical treatments were identified as either: anterior cervical discectomy and fusion (ACDF), posterior laminectomies, posterior cervical fusion or combined anterior/posterior surgery. Preexisting PD was identified. Endpoints included mortality, length of stay (LOS), swallowing dysfunction measured by placement of feeding tube (NGT), and postprocedure pneumonia. RESULTS A total of 73,088 patients underwent surgical procedures for CSM during the study period. Of those, 552 patients (7.5%) had concomitant PD. The most common procedure was ACDF. Patients with PD had a higher rate of dysphagia (NGT placement) after surgery compared with those without PD (P<0.001). Multiple regression analysis showed that PD patients had a higher risk of having NGT placement or developing pneumonia [odds ratio 2.98 (1.7-5.2), P<0.001] after surgery.Patients with PD who underwent ACDF, posterior laminectomies or posterior cervical fusion had a longer LOS compared with those who did not have PD (P<0.001). There was no difference in LOS for patients who underwent combined anterior/posterior surgery. Inpatient mortality was higher in patients with PD who underwent ACDF or combined surgery (P<0.001). CONCLUSIONS While ACDF is the most commonly performed procedure for CSM in patients with PD, it is associated with longer LOS, higher incidence of postoperative dysphagia, and postprocedural pneumonia, as well as higher inpatient mortality compared with posterior cervical procedures. LEVEL OF EVIDENCE Level III.
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Su XW, Simmons Z. Laryngospasm: A Frequently Underrecognized Symptom in Amyotrophic Lateral Sclerosis. Muscle Nerve 2022; 65:367-368. [PMID: 35092060 DOI: 10.1002/mus.27510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Xiaowei W Su
- Department of Neurology, Penn State Health M.S. Hershey Medical Center, Hershey, Pennsylvania
| | - Zachary Simmons
- Department of Neurology, Penn State Health M.S. Hershey Medical Center, Hershey, Pennsylvania
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Gotesman RD, Lalonde E, McKim DA, Bourque PR, Warman-Chardon J, Zwicker J, Breiner A. Laryngospasm in amyotrophic lateral sclerosis. Muscle Nerve 2021; 65:400-404. [PMID: 34817079 DOI: 10.1002/mus.27466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Laryngospasm is an involuntary, sustained closure of sphincter musculature that leads to an unpleasant subjective experience of dyspnea and choking. It is an underreported symptom in amyotrophic lateral sclerosis (ALS). In this study we aimed to better characterize the prevalence and clinical characteristics of laryngospasm in ALS patients. METHODS The medical records of 571 patients with ALS followed between 2008 and 2018 were searched for evidence of laryngospasm. A total of 23 patients with laryngospasm were identified and the data related to patient and laryngospasm characteristics were extracted. RESULTS Laryngospasm was reported in 4% of ALS patients. Females comprised 57% of patients and their mean age was 63.4 years. Laryngospasm frequently manifested in patients with moderate bulbar dysfunction and seemed independent of respiratory function. Among laryngospasm patients, 26% were cigarette smokers and 13% had a history of gastroesophageal reflux. The most common reported trigger was excessive saliva irritating the vocal cords (35%) followed by eating a meal (17%). There was significant variation in laryngospasm frequency (up to 5 per hour) and duration (seconds to minutes). Most patients could not identify an effective coping mechanism, although 13% reported that drinking water was effective. DISCUSSION Despite its low prevalence in ALS, laryngospasm should be included in the symptom inquiry. The present findings may improve patient care through increased recognition of the clinical features of laryngospasm in ALS patients, identifying a link between laryngospasm and moderate bulbar dysfunction, and highlighting trigger avoidance as a management strategy. Additional research is required to understand the pathophysiology and optimal treatment.
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Affiliation(s)
- Ryan D Gotesman
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Emilie Lalonde
- Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas A McKim
- Division of Respiratory Medicine, CANVent Respiratory Rehabilitation Services, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Pierre R Bourque
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Jodi Warman-Chardon
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Jocelyn Zwicker
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Breiner
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
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Paroxysmal Laryngospasm: A Rare Condition That Respiratory Physicians Must Distinguish from Other Diseases with a Chief Complaint of Dyspnea. Can Respir J 2020; 2020:2451703. [PMID: 32695244 PMCID: PMC7361892 DOI: 10.1155/2020/2451703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/19/2020] [Accepted: 06/10/2020] [Indexed: 12/21/2022] Open
Abstract
Background In recent years, we have observed respiratory difficulty manifested as paroxysmal laryngospasm in a few outpatients, most of whom were first encountered in a respiratory clinic. We therefore explored how to identify and address paroxysmal laryngospasm from the perspective of respiratory physicians. Methods The symptoms, characteristics, auxiliary examination results, treatment, and prognosis of 12 patients with paroxysmal laryngospasm treated in our hospital from June 2017 to October 2019 were analyzed. Results Five males (42%) and 7 females (58%) were among the 12 Han patients sampled. The average age of the patients was 49.25 ± 13.02 years. The disease course ranged from 14 days to 8 years and was characterized by sudden dyspnea, an inability to inhale and exhale, a sense of asphyxia, and voice loss during an attack. Eight patients with gastroesophageal reflux were cured after antacid treatment. One case of upper respiratory tract infection (URI) was completely relieved after symptomatic treatment. One patient with left vocal cord paralysis experienced complete relief after specialist treatment by an otorhinolaryngologist. Episodes in 1 patient were significantly reduced after lifestyle improvement. One patient experienced spontaneous relief after rejecting treatment. Conclusions Paroxysmal laryngospasm is a rare laryngeal disease that generally occurs secondary to gastroesophageal reflux disease (GERD), and antireflux therapy is frequently effective for its treatment. A respiratory physician should master and identify the symptoms and differentiate this condition from hysterical stridor, reflux-related laryngospasm, and asthma. Timely referral to otolaryngologists, gastroenterologists, and other specialists for standardized examination and regular treatment should be provided when necessary.
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Terenzi F, Locatello LG, Novelli A, Gallo O, Ramat S. Recurrent laryngospasm as the only presenting feature of multiple system atrophy. Neurol Sci 2020; 41:2629-2630. [PMID: 32239345 DOI: 10.1007/s10072-020-04373-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Federica Terenzi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Pieraccini 6, 50139, Florence, Italy.
| | - Luca Giovanni Locatello
- Clinic of Otorhinolaryngology, Department of Surgery and Translational Medicine, University of Florence, Florence, FI, Italy
| | - Alessio Novelli
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Pieraccini 6, 50139, Florence, Italy
| | - Oreste Gallo
- Clinic of Otorhinolaryngology, Department of Surgery and Translational Medicine, University of Florence, Florence, FI, Italy
| | - Silvia Ramat
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Pieraccini 6, 50139, Florence, Italy
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Khan A, Kurtz B, Ambardekar A. Lessons Learned From a Burn-Injured Pediatric Patient With Dandy-Walker Syndrome After Multiple Anesthetics: A Case Report. A A Pract 2019; 13:166-168. [PMID: 30985318 DOI: 10.1213/xaa.0000000000001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dandy-Walker syndrome is a rare congenital brain malformation that requires unique anesthetic considerations. We present a rare case of an 18-month-old boy with Dandy-Walker syndrome presenting with 17% total body surface area burns undergoing multiple general anesthetics for both operative and bedside procedures. Numerous lessons were learned during multiple anesthetics, which influenced and guided our subsequent anesthetic management. The preoperative assessment, risk for respiratory apnea, opioid management, risk for laryngospasm, and postoperative care of patients with Dandy-Walker syndrome were all lessons learned.
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Affiliation(s)
- Asif Khan
- From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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Laryngospasmus bei Amyotropher Lateralsklerose. Wien Med Wochenschr 2018; 168:184-188. [DOI: 10.1007/s10354-018-0620-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 01/25/2018] [Indexed: 11/25/2022]
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Roberts DP, Lewis SJG. Considerations for general anaesthesia in Parkinson's disease. J Clin Neurosci 2017; 48:34-41. [PMID: 29133106 DOI: 10.1016/j.jocn.2017.10.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/23/2017] [Indexed: 12/19/2022]
Abstract
Parkinson's disease is a common neurodegenerative disorder in the elderly which when present has a significant influence on surgical management. These patients necessitate additional perioperative and anaesthetic considerations across disease specific domains as well as in relation to the respiratory and cardiovascular systems. This brief review focuses on the factors which contribute to perioperative morbidity, including the use of medications that may exacerbate symptoms or adversely interact with treatments for Parkinson's disease. Recommended dosing practices to reduce complications during hospitalisation are covered. In addition, recent concerns regarding anaesthetic exposure in early childhood as a risk factor for the development of Parkinson's disease are discussed in light of data from animal models of anaesthetic neurotoxicity and epidemiological studies.
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Affiliation(s)
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia.
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von Eckardstein KL, Sixel-Döring F, Kazmaier S, Trenkwalder C, Hoover JM, Rohde V. Asphyxia due to laryngeal spasm as a severe complication of awake deep brain stimulation for Parkinson's disease: a case report. BMC Neurol 2016; 16:216. [PMID: 27821134 PMCID: PMC5100222 DOI: 10.1186/s12883-016-0736-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In accordance with German neurosurgical and neurological consensus recommendations, lead placements for deep brain stimulation (DBS) in patients with Parkinson's disease (PD) are usually performed with the patient awake and in "medication off" state. This allows for optimal lead position adjustment according to the clinical response to intraoperative test stimulation. However, exacerbation of Parkinsonian symptoms after withdrawal of dopaminergic medication may endanger the patient by inducing severe "off" state motor phenomena. In particular, this can be a problem in awake craniotomies utilizing intraoperative airway management and resuscitation. CASE PRESENTATION We report the case of a PD patient with progressive orofacial and neck muscle dystonia resulting in laryngeal spasm during DBS lead placement. This led to upper airway compromise and asphyxia, requiring resuscitation. CONCLUSIONS Laryngeal spasms may occur as a rare "off" state motor complication in patients with PD. Other potential causes of intraoperative difficulties breathing include bilateral vocal cord palsy, positional asphyxia, and silent aspiration. In our practice, we have adjusted our medication regimen and now allow patients to receive their standard dopaminergic medication until the morning of surgery. Neurologists and neurosurgeons performing lead placement procedures for PD should be aware of this rare but unsafe condition to most optimized treatment.
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Affiliation(s)
- Kajetan L von Eckardstein
- Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | | | - Stephan Kazmaier
- Department of Anasthesiology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Claudia Trenkwalder
- Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.,Paracelsus Elena-Klinik, Kassel, Germany
| | | | - Veit Rohde
- Department of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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Laryngospasm as preceding symptom of amyotrophic lateral sclerosis. J Neurol 2010; 257:1929-30. [DOI: 10.1007/s00415-010-5626-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 06/01/2010] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
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Abstract
Numerous neurologic diseases affect voice production either through direct effects on the larynx or by affecting muscles involved with support or resonation of the voice. Voice changes can be the initial presenting symptoms of neurodegenerative disorders, especially in patients who have increased awareness of their vocal quality. Some patients present to the otolaryngologist before the neurologist. The otolaryngologist must have an understanding and familiarity with laryngeal manifestations of neurodegenerative diseases to make the appropriate diagnosis in a timely fashion. Moreover, the otolaryngologist can play a significant role in the care of patients who have neurodegenerative disease. Video procedures for neurolaryngologic evaluation accompany this content online.
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Affiliation(s)
- Adam D Rubin
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose and Throat Center, 21000 E. Twelve Mile Road, Suite 111, Saint Clair Shores, MI 48081, USA.
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Abstract
To increase awareness of sudden and unexpected death in Lesch-Nyhan disease (LND) and to explore its potential causes, we report the anteceding clinical features and laboratory evaluations of five males with LND who ultimately experienced sudden and unexpected death, along with three additional males who suffered serious respiratory events during life. The ages of patients ranged from 2 to 45 years. The cause of sudden death in LND appears to have a respiratory rather than a cardiogenic basis. All cases cannot be linked readily with a single respiratory process. Instead, different respiratory processes appear to operate in different cases. These may include aspiration, laryngospasm, central apnea, cyanotic breath-holding spells, and high cervical spine damage. Better recognition of these processes will help to guide appropriate workup and management that could include chest imaging, endoscopy of the airways, polysomnography, electroencephalogram, and brain and/or spine imaging.
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Affiliation(s)
| | - H A Jinnah
- Correspondence to second author at Meyer Room 6-181, Department of Neurology, Johns Hopkins University, Baltimore, MD 21287, USA.
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