Vocal @entity717 are increasingly recognized in @entity1 with @entity746 ( @entity746 ). We describe a @entity1 with limb-onset @entity746 who developed @entity3746 . A 74-year-old Japanese male consulted our clinic with a 6-month history of @entity425 in both arms. His family history was unremarkable. There were @entity2901 and mild @entity194 and both arms. In the legs, muscle strength was almost normal but widespread @entity2901 were present. All tendon reflexes were hypoactive and pathological reflexes were absent. Thereafter, he developed @entity425 and showed increased eating time. Babinski sign was positive bilaterally at this stage. The forced vital capacity dropped from 90% at the initial evaluation to 62% of the predicted value 14 months later. Two years after disease onset, the @entity1 developed @entity1174 with hoarseness and had difficulty clearing his throat of phlegm. Laryngoscopy demonstrated severe @entity3746 on both sides, particularly in the abductor muscles possibly leading to obstruction. Tracheotomy was performed because of the risk that the @entity1 could @entity1224 to @entity204 . A review of the literature suggests that severe @entity602 could be a prelude to @entity944 in @entity746 . Follow up by laryngoscopic examination is necessary.

[A case of XXXX with bilateral @entity3746 necessitating tracheotomy].

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity944 :: ('MESH:D003645', 'Disease') :: ['sudden death'] @entity602 :: ('MESH:D013118', 'Disease') :: ['impairment of vocal cord abduction'] @entity425 :: ('MESH:D018908', 'Disease') :: ['weakness of the legs', 'weakness'] @entity2901 :: ('MESH:D005207', 'Disease') :: ['fasciculations'] @entity1174 :: ('MESH:D011015', 'Disease') :: ['aspiration pneumonia'] @entity194 :: ('MESH:D001284', 'Disease') :: ['atrophy of the tongue'] @entity746 :: ('MESH:D000690', 'Disease') :: ['ALS', 'amyotrophic lateral sclerosis'] @entity717 :: ('MESH:D009069', 'Disease') :: ['cord movement disorders'] @entity3746 :: ('MESH:D014826', 'Disease') :: ['vocal cord paresis', 'vocal cord paralysis'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death'] @entity1224 :: ('MESH:D000402', 'Disease') :: ['choke']
@entity746 :: (MESH:D000690,Disease) :: ['amyotrophic lateral sclerosis']
