Estridor y dificultad respiratoria: aproximación neurológica: caso clínico / Stridor and dyspnea caused by a conversion disorder: a case report

Paradoxical vocal cord motion or vocal cord dysfunction is a descriptive term for an inappropriate adduction of the vocal cords during respiration, which can cause respiratory obstruction and stridor. It is associated with psychiatric conditions in the great majority of cases. We report a 23 year-old high performance female athlete, referred for a recurrent bilateral paralysis of the vocal cords, with a history of four intensive care unit admissions for severe dyspnea and stridor, which were treated several times with intubation and with tracheostomy on two occasions. Myasthenia gravis was suspected and she was treated with pyridostigmine and prednisone. She was discharged but despite the treatment, she presented new episodes of stridor and was readmitted six months later. This time the pharmacological treatment was suspended. The neurological study disclosed a normal brain magnetic resonance, normal cerebrospinal fluid analysis and a normal electromyography. A conversion disorder was suspected and the patient was successfully treated with psychotherapy.

Paraparesia espástica progresiva idiopática HTLV-I seronegativa: estudio clínico y neurofisiológico de las manifestaciones sensitivas / HTLV-I seronegative idiopathic progressive spastic paraparesis: clinical and neurophysiological study of the sensory features

Background: HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a defined entity. However, there are many patients not well characterized with a similar clinical picture who are HTLV-I seronegative. Objective: Clinical and neurophysiological description of patients with HTLV-I seronegative idiopathic paraparesia. Patients and Methods: Seventeen patients (4 women and 13 men aged 24-67 years, average 52.3) were evaluated including clinical assessment, vibratory sensory analysis, quantitative somatosensory thermotest (QST), somatosensory evoked potentials (SSEPs), electromyography (EMG) and motor and sensory nerve conductions. Results: In addition to the spastic paraparesis, 3 (17.6 percent) patients had pseudobulbar symptoms. Ten (58.8 percent) patients had a spastic gait but could walk unaided, 6 (35.2 percent) needed support and 1 patient could not walk. Bladder dysfunction was found in 10 (58.8) patients and sensory symptoms in 7 (41.1 percent). There was mild distal impairment of vibration and position sense, distal tactile and pinprick hypoesthesia in 4 (23.4 percent) patients. Tibial SSEPs were abnormal in 11 (64.7 percent). Nerve conduction studies and EMG were normal. QST showed cold hypoesthesia in 14 (82.4 percent) patients. Warm sensation and heat pain appeared unimpaired. Conclusions: All sensory abnormalities found were restricted to sensations carried by myelinated (A beta and A delta) channels. Sensory and motor abnormalities are similar to HAM/TSP patients suggesting a common pathogenesis

Miopatía por déficit de maltasa ácida en el adulto / Myopathy due to acid maltase deficiency in an adult patient

We report a 46 years old male presenting with tetraparesis and severe respiratory involvement. He had moderately elevated serum creatine phosphokinase values and the electromyography showed myopathic alterations and irritative signs. In the muscle biopsy a vacuolar myopathy with increased collagen deposits was found. Circulating lymphocytes presented abnormal PAS positive granules in their cytoplasm