Objective: We present two cases of bilateral vocal cord paralysis (BVCP) associated with idiopathic Parkinson’s disease (iPD).

Background: BVCP is a rare complication associated with iPD, and usually has stronger association with Multi-system atrophy (MSA). We describe two patients who presented with BVCP, the available management strategies, and the clinical reasons why palliative care was chosen as the management in both cases.

Method: A 78-year-old lady presenting with a 3-month history of progressive dyspnoea, was subsequently diagnosed with BVCP. She had iPD Hoehn and Yahr stage 4 and co-existent frailty. In collaboration with a throat surgeon and her movement disorder team, treatment options and their associated risks were discussed with her. She made an informed decision to pursue palliative care at home.

An 82-year-old male presented acutely to hospital with clinical concerns related to aspiration pneumonia, and was identified to have stridor and BVCP. He had advanced, Hoehn and Yahr stage 5 disease with dementia. A best-interests meeting took place and, given the surgical risks, quality of life implications and limited prognostic benefit that would be achieved from surgical intervention or tracheostomy, a decision was made to utilise palliative care for management of BVCP in this case also.

Results: The pathophysiology of VCP in iPD is yet to be fully evaluated. It is important if a patient with iPD develops BVCP, their original diagnosis of iPD be re-examined carefully to ensure their condition does not represent a parkinsonism-dominant form of MSA.
Neurogenic atrophy of the posterior cricoarytenoid muscles and dystonia of vocal cord adductor muscles has been implicated as playing a causal role in BVCP in MSA, though further research is required to determine the causal features in iPD. The primary treatment options for the management of stridor associated BVCP are continuous positive airway pressure (CPAP), tracheostomy and vocal cordotomy. In certain patients, as described here, palliative care must also be considered in conjunction with these.

Conclusion: BVCP is a rare but recognised complication of iPD. A number of management strategies are available to patients and their treating physicians when faced with this problem. The quality of life implications of these management options including palliative care need to be carefully weighed with each patient, particularly when BVCP presents in the later stages of iPD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/bilateral-vocal-cord-paralysis-associated-with-idiopathic-parkinsons-disease/