Subacute Horizontal Diplopia, Jaw Dystonia, and Laryngospasm

Nanthaya Tisavipat; Bryce K Chang; Farwa Ali; Sean J Pittock; Ryan Kammeyer; Anthony Declusin; Samuel J Cohn; Eoin P Flanagan

doi:10.1212/NXI.0000000000200128

Subacute Horizontal Diplopia, Jaw Dystonia, and Laryngospasm

Neurol Neuroimmunol Neuroinflamm. 2023 Jun 13;10(4):e200128. doi: 10.1212/NXI.0000000000200128. Print 2023 Jul.

Authors

Nanthaya Tisavipat¹, Bryce K Chang¹, Farwa Ali¹, Sean J Pittock¹, Ryan Kammeyer¹, Anthony Declusin¹, Samuel J Cohn¹, Eoin P Flanagan²

Affiliations

¹ From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO.
² From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO. [email protected].

Abstract

Jaw dystonia and laryngospasm in the context of subacute brainstem dysfunction have been described in a small number of diseases, including antineuronal nuclear antibody type 2 (ANNA-2, also known as anti-Ri) paraneoplastic neurologic syndrome. Severe episodes of laryngospasms causing cyanosis are potentially fatal. Jaw dystonia can also cause eating difficulty, resulting in severe weight loss and malnutrition. In this report, we highlight the multidisciplinary management of this syndrome associated with ANNA-2/anti-Ri paraneoplastic neurologic syndrome and discuss its pathogenesis.

MeSH terms

Antibodies, Antinuclear
Diplopia
Dystonia* / diagnosis
Dystonia* / etiology
Humans
Laryngismus* / complications
Laryngismus* / diagnosis
Paraneoplastic Syndromes, Nervous System*

Substances

Antibodies, Antinuclear