63-year-old woman with dysphonia, dysphagia, and sleep apnea

• Type of Material: Article
• Authors: Efstathia Andrilopoulou, Jefferson Medical College; Carla Ellis, Emory University; Barbara J Crain, Johns Hopkins School of Medicine
• Language: English
• Date: 2014-01-01
• Publisher: John Wiley & Sons, Inc
• Publication Version: Final Published Version
• Copyright Statement: © 2014 International Society of Neuropathology
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1111/bpa.12157
• Title of Journal or Parent Work: Brain Pathology
• Volume: 24
• Issue: 4
• Start Page: 423
• End Page: 424
• Keywords: Multiple System Atrophy; Humans; Deglutition Disorders; Dysphonia; Spinal Cord; Brain; Female; Middle Aged; Sleep Apnea Syndromes; Immunohistochemistry; Fatal Outcome; Diagnosis, Differential
• Research Categories: Health Sciences, Pathology; Health Sciences, Medicine and Surgery

Abstract

An obese and hypertensive 63‐year‐old Caucasian woman presented with persistent and progressively worsening exertional dyspnea, occasionally accompanied by anginal chest pain as well as dysphonia, hoarseness, dysphagia, complaints of lower extremity weakness, and documented mild chronic L5‐S1 denervation. Work‐up revealed moderate obstructive ventilatory defect, borderline restrictive defect, and variable extrathoracic obstruction. Weakness and progressively poor quality of sleep characterized by sleep‐disordered breathing, increased daytime somnolence, fatigue upon waking and increased snoring were added to her initial complaints. A sleep study established the diagnosis of severe obstructive sleep apnea. Treatment with continuous positive airway pressure (CPAP) produced significant improvement in her energy levels, more restful sleep and less fatigue, but her dyspnea worsened. A new cycle of cardiac and respiratory evaluation was positive for mild pulmonary hypertension and negative for myocardial ischemia and pulmonary fibrosis. Shortly after these last assessments, and two to three years after onset of symptoms, the patient died suddenly in her sleep.