A 74-year-old farmer presented to the emergency department with a subacute history of progressive dyspnoea, wheeze and dysphonia. He was treated for an exacerbation of asthma with poor response to pharmacological therapy. Investigation of dysphonia via laryngoscopy identified a bilateral vocal cord palsy. Subsequently, the patient developed an episode of life-threatening stridor and hypercapnic respiratory failure requiring an emergency tracheostomy. Neurology input identified evidence of widespread muscle fasciculations on clinical examination. MRI of the brain and cervical spine were unremarkable. Electromyogram testing identified changes of acute denervation in several limbs consistent with a diagnosis of motor neuron disease (MND). Bilateral vocal cord palsy has been rarely reported in the literature as the heralding symptom resulting in the diagnosis of MND. In patients with a subacute onset of dysphonia, dyspnoea and stridor, MND should be a differential diagnosis.
- motor neurone disease
- neuro genetics
- neuromuscular disease
- nose and throat/otolaryngology
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Contributors All authors have approved the manuscript and this submission. All authors were involved in the diagnosis and management of the patient in the report. All additional authors have been involved with writing the paper. BG was the lead author and was in charge of data collection, analysis, literature review and final editing of the paper. EJ was the neurology registrar caring for the patient and was responsible for initial investigations and the long-term management of the patient. She has also taken a large role in proofreading and editing the paper. TJC was consultant in charge of caring for the patient. He was involved in writing and editing the paper.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer-reviewed.