-Case Reports-

A Case of Unilateral Recurrent Nerve Palsy with Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Taro Komachi¹, Hideto Saigusa², Osamu Kadosono², Hiroyuki Ito², Satoshi Yamaguchi³, Hiroshi Nagayama⁴ and Masanori Sakamaki⁵

¹Department of Otolaryngology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
²Department of Otolaryngology and Pediatric Otolaryngology, Tokyo Women's Medical University, Yachiyo Medical Center, Chiba, Japan
³Department of Otolaryngology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
⁴Department of Neurology, Nippon Medical School Hospital, Tokyo, Japan
⁵Department of Neurology, Nippon Medical School MusashiKosugi Hospital, Kanagawa, Japan

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a disease in which peripheral sensory and motor nerves of the four limbs are impaired due to autoimmune mechanism-induced demyelinating changes through a 2-month or longer chronic course. The incidence of complication by cranial neuropathy has been reported to be 15%, but there have been very few reports on disorder of the vagus nerve and its branch, the recurrent nerve. We report a patient who developed left recurrent nerve palsy with CIDP. The patient was a 48-year-old male. The disease developed as progressive muscle weakness and numbness of the four limbs 3 years before and was diagnosed as CIDP. The symptoms had been improved by high-dose intravenous gamma-globulin therapy. However, from 2 months before he became aware of breathy hoarseness, and bilateral decreased grip strength and sensory disturbance of the upper and lower limbs recurred and progressed. On laryngoscopy disorder of left vocal fold movement and glottal closure incompetence during phonation were observed, and neurogenic changes were detected in the left thyroarytenoid muscle by needle electromyography for the intrinsic laryngeal muscles. High-dose intravenous gamma-globulin therapy was performed and left vocal fold movement recovered with recovery of bilateral grip strength and sensory disturbance of the upper and lower limbs, and phonation was also normalized.

J Nippon Med Sch 2022; 89: 562-567

Keywords
chronic inflammatory demyelinating polyradiculoneuropathy, recurrent nerve palsy, hoarseness, electromyography

Correspondence to
Taro Komachi, Department of Otolaryngology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba 270-1694, Japan
s6031@nms.ac.jp

Received, April 7, 2021
Accepted, August 4, 2021