Hemilaryngopharyngeal spasm [Neurosurgery Wiki]

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====== Hemilaryngopharyngeal spasm ======

[[Christopher R. Honey]] et al., from the University of [[British Columbia]], [[Vancouver]], [[Canada]] described a condition, [[hemilaryngopharyngeal spasm]] (HELPS), which can cause severe episodic [[stridor]] leading to [[unconsciousness]] in association with [[cough]]. The first recognized and surgically cured [[patient]] with [[HELPS]] was reported in [[2017]] 
((Honey CR, Gooderham, P, Morrison, M, Ivanishvili, Z:
Episodic hemilaryngopharyngeal spasm (HELPS) syndrome:
case report of a surgically treatable novel neuropathy. J Neurosurg
126:1653–1656, 2017)).

Three additional patients have been followed up for at least a year postoperatively.

Each patient presented with a similar pattern of [[episodic]] coughing and [[choking]] that increased in frequency, severity, and duration over years. The episodes eventually occurred while sleeping and could cause severe stridor with loss of [[consciousness]]. All three patients were initially misdiagnosed with a [[psychiatric]] illness and subjected to multiple [[intubation]]s and one [[tracheostomy]]. Unilateral [[botulinum toxin]] injections in the vocal fold eased the severity of the throat contractions but not the cough. [[Magnetic resonance imaging]] showed a looping [[posterior inferior cerebellar artery]] juxtaposed to a [[vagus nerve]] in each case. [[Microvascular decompression]] (MVD) of that vessel relieved all symptoms. The introduction of this new medical condition may help a small cohort of patients with inducible [[laryngeal obstruction]]s that have not responded to the current standard treatments. Patients are asymptomatic between episodes of progressively severe coughing and choking with stridor that may lead to intubation. Severe [[anxiety]] about the unpredictable symptoms is expected and may contribute to a psychiatric misdiagnosis. [[Microvascular decompression]] for HELPS is more difficult than that for [[trigeminal neuralgia]] because the involved nerve is more susceptible to manipulation. Ultimately, the final proof that HELPS is a real and distinct syndrome will require its recognition and successful treatment by colleagues around the world
((Honey CR, Morrison MD, Heran MKS, Dhaliwal BS. Hemi-laryngopharyngeal spasm as
a novel cause of inducible laryngeal obstruction with a surgical cure: report of 
3 cases. J Neurosurg. 2018 Jul 20:1-5. doi: 10.3171/2018.2.JNS172952. [Epub ahead
of print] PubMed PMID: 30028264.
)).