Estridor y dificultad respiratoria: aproximación neurológica. Caso clínico

Abstract

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.