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To the Editor:
We read with interest the article by Benarroch et al.1 concerning laryngeal strider (LS) in multiple system atrophy (MSA). They report that the number of neurons is preserved in the dorsal regions of the nucleus ambiguus (NA), but not in the ventrolateral regions. We also studied clinicopathologic changes in patients with MSA with or without LS. We would like to discuss and compare their results and ours.
Neurologic examination and autopsy were performed in six patients with MSA (three men and three women) with a clinical diagnosis of Shy-Drager syndrome. The mean (± SD) age and duration of MSA were 53.8 ± 9.0 years and 2.3 ± 1.5 years. Three patients had LS. LS occurred in the terminal stage of MSA and the duration of LS (mean ± SD) was 6.0 ± 0.4 months. Cerebellar ataxia and autonomic dysfunction, including orthostatic hypotension, neurogenic bladder dysfunction, Horner signs, and decreased R-R interval variance on electrocardiogram, were present in all patients. Four patients had parkinsonism. Clinical features indicated that LS was correlated with severity of parkinsonism and autonomic dysfunction. There was no relationship between LS and duration of MSA. Autopsy studies were compared between those MSA patients and five age-matched patients with non-neurologic diseases. The morphometric analyses were done …
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