Bilateral vocal fold paresis as first symptom of amyotrophic lateral sclerosis

Introduction:

Vocal fold paresis as initial manifestation of amyotrophic lateral sclerosis (ALS) occurs only in a very small number of affected patients. In bulbar-onset ALS speech and swallowing difficulties are often the initial signs of the disease.

Methods:

We present a case report of a patient diagnosed with bilateral vocal fold paresis after a respiratory infection and describe the clinical findings, the diagnostics as well as the progression of the disease until determination of the underlying cause.

Results:

Eight months passed since the diagnosis of bilateral vocal fold paresis and the subsequent diagnosis of ALS. Seven months after the patient's first consultation additional symptoms such as dysarthria and tongue fasciculation had appeared. Further neurologic examination was performed. Despite a bulbar-onset ALS and a progression of dysarthria, there was no substantial swallowing disorder six month after the diagnosis of ALS.

Discussion:

After exclusion of common differential diagnosis of bilateral vocal fold paresis (malignant disease and especially recurrent laryngeal nerve injury due to thyroid surgery) systemic/neurological diseases should be taken into account. A regular follow-up is imperative in order to reduce the risk of missing a progression of an underlying systemic disease.

Publication History

Publication Date:
18 April 2018 (online)