ACUTE BILATERAL VOCAL CORD PARALYSIS (BVCP) IN A PATIENT WITH UNDIAGNOSED DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS (DISH)

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: BVCP typically presents after iatrogenic injury from neck surgery or tracheal intubation, neurologic disorders, organophosphate toxicity, stroke, brainstem compression. Here we present a case of likely secondary to DISH. CASE PRESENTATION: A 61-year-old male with schizophrenia, traumatic brain suicide attempt fourteen years ago residual slurred speech and dysphagia, stridor difficulty breathing. Vital signs were within normal. Physical exam revealed cachectic patient in moderate respiratory distress, loud inspiratory stridor, periods apnea. He was given racemic epinephrine, dexamethasone, lorazepam without improvement. Direct laryngoscopy but the retained ability phonate. Patient underwent emergent tracheostomy, where mild scarring wall defect previous tracheostomy noted. Computed Tomography (CT) Head negative. X-ray CT extensive ossification anterior longitudinal ligament (ALL) C2-C7 indenting aerodigestive tract (Figures 1 2). The remained patent throughout its length. His hospitalization complicated by pneumomediastinum healthcare associated pneumonia resistant bacteria, mucus plugging. also required gastrostomy tube for nutrition. eventually discharged inpatient hospice. DISCUSSION: ALL seen our due an undiagnosed DISH is systemic condition spine peripheral entheses; these ossifications do not involve degenerative change span minimum four contiguous vertebrae. Cervical involvement asymptomatic, may lead decreased mobility, dyspnea. In rare cases, cervical can BVCP, incidence which unknown has only been reported reports. Our had distant history anoxic dysphagia tracheostomy. It unclear if played significant role his alone. CONCLUSIONS: Acute uncommon cause dyspnea that have higher post-anoxic patients. REFERENCE #1: Bakker JT, Kuperus JS, Kuijf HJ, Oner FC, de Jong PA, Verlaan JJ. Morphological characteristics diffuse idiopathic skeletal hyperostosis spine. PLoS One. 2017 Nov 20;12(11):e0188414. doi: 10.1371/journal.pone.0188414. PMID: 29155874. #2: Benninger MS, Gillen JB, Altman JS. Changing etiology vocal fold immobility. Laryngoscope. 1998 Sep;108(9):1346-50. #3: Sebaaly A, Boubez G, Sunna T, Wang Z, Alam E, Christopoulos Shedid D. Diffuse Idiopathic Hyperostosis Manifesting as Dysphagia Bilateral Cord Paralysis: Report Literature Review. World Neurosurg. 2018 Mar;111:79-85. 10.1016/j.wneu.2017.12.063. Epub Dec 18. 29269071. DISCLOSURES: No relevant relationships Meghan Beard, source=Web Response William Buniak, David Capone, Epstein, Kashif Hussain, Elnaz Mahbub, Kathryn Saxby, Daisy Young,