Airway Obstruction Caused by Mucinous Material Adherent to the Epiglottis in a Patient with a Progressive Neurological Disorder: An Unusual Case of a Condition Mimicking Acquired Laryngomalacia

We herein report the successful management of a condition mimicking acquired laryngomalacia using conservative methods in an elderly man with a progressive neurological disorder. The patient developed stridor and was transferred to the intensive-care unit. Flexible laryngoscopy revealed a collapsed epiglottis during inspiration, as seen in acquired laryngomalacia, with mucinous material firmly adhered to the epiglottis. The stridor resolved after the removal of this material. Pathology revealed keratinized material, suggesting a collection of sputum or epithelial tissue. Thus, flexible laryngoscopy can differentiate the cause of airway obstruction and avoid unnecessary endotracheal intubation in patients with neurological disorders.

Consistent affection of the central somatosensory system in spinocerebellar ataxia type 2 and type 3 and its significance for clinical symptoms and rehabilitative therapy

The spinocerebellar ataxias type 2 (SCA2) and type 3 (SCA3) are progressive, currently untreatable and ultimately fatal ataxic disorders, which belong to the group of neurological disorders known as CAG-repeat or polyglutamine diseases. Since knowledge regarding the involvement of the central somatosensory system in SCA2 and SCA3 currently is only fragmentary, a variety of somatosensory disease signs remained unexplained or widely misunderstood. The present review (1) draws on the current knowledge in the field of neuroanatomy, (2) describes the anatomy and functional neuroanatomy of the human central somatosensory system, (3) provides an overview of recent findings regarding the affection of the central somatosensory system in SCA2 and SCA3 patients, and (4) points out the underestimated pathogenic role of the central somatosensory system for somatosensory and somatomotor disease symptoms in SCA2 and SCA3. Finally, based on recent findings in the research fields of neuropathology and neural plasticity, this review supports currently applied and recommends further neurorehabilitative approaches aimed at maintaining, improving, and/or recovering adequate somatomotor output by enforcing and changing somatosensory input in the very early clinical stages of SCA2 and SCA3.

[Type 2 spinocerebellar ataxia: an experience in psychological rehabilitation]

INTRODUCTION

Psychological rehabilitation in patients with neurodegenerative disorders helps to improve their quality of life and provide the most suitable approach to their disease. There are no records of this type of treatment being used in type 11 spinocerebellar ataxia.

OBJECTIVES

To evaluate the efficacy of group therapy within the framework of psychological rehabilitation and determine the most favored psychological function markers.

PATIENTS AND METHODS

This study is a quasi experimental study of 24 patients with type 2 spinocerebellar ataxia rehabilitated in the CIRAH (Cuba). The procedure involved psychological assessment before and after the strategy for intervention, which consisted of 15 sessions of group therapy.

RESULTS

The pathological levels of anxiety were reduced in 50.1% of the cases, and 31.4% of the patients with depression improved. The self assessment markers of a taking step forward were happiness and worry level. The disorder affected all aspects of the life of the patients studied, particularly their interests, family, self esteem and work.

CONCLUSIONS

It is possible to improve the attitude of the patient to his disease and his psychological function by means of group therapy during the process of psychological rehabilitation of patients with type 2 spinocerebellar ataxia.