Adductor laryngeal exhaling dystonia in progressive supranuclear palsy

An 80-year-old woman with a 7-year history of progressive supranuclear palsy had periodic dyspnea attacks that lasted for several hours. During these attacks, she involuntarily groaned because she could barely exhale but could inhale (video 1 on the Neurology(R) Web site at Neurology.org). When she was instructed to pronounce words, she could do this voluntarily and phonation enabled her to exhale. Laryngoscopy revealed that her vocal cords opened during inspiration but closed during expiration (video 2). This was a case of laryngeal dystonia[1,2] and may be a rare example of respiratory disorders resulting from adductor laryngeal exhaling dystonia (appendix e-1).