Multiple system atrophy (MSA) is a neurodegenerative disease that is associated with cerebellar symptoms, autonomic symptoms and parkinsonism as three significant signs. The prevalence of MSA is 7-10 per 100 , 000 population, thus, among neurodegenerative diseases, it is not a rare condition.MSA is known to be associated with vocal cord paralysis, and its onset often occurs during the progression of the disease and rare in the early stage of the disease. We herein report two cases of MSA in which the initial symptoms was bilateral vocal cord abductor paralysis.Case 1 : A 67 -year-old woman presented to our hospital with a chief complaint of stridor and respiratory distress. Laryngeal fiberscopy revealed bilateral vocal cord abductor paralysis. She had no symptoms other than stridor and respiratory distress. Considering the possibility of central bilateral vocal cord abductor paralysis, we consulted with the neurology department. Examinations at the neurology department revealed autonomic neuropathy, followed by a diagnosis of MSA. Four months later, she received tracheotomy because of an exacerbation of respiratory distress.Case 2 : A 77 -year-old man presented to our hospital with a chief complaint of stridor. Laryngeal fiberscopy revealed bilateral vocal cord abductor paralysis. A detailed examination was performed at the neurology department, but no obvious abnormality was observed. One year later, the patient underwent Ejnell's operation at another hospital. Three years after surgery, he complained of symptoms, which were suspected to be associated with autonomic dysfunction. He was examined again by the neurology department and diagnosed with MSA.The acute exacerbation of bilateral vocal cord abductor paralysis can cause sudden death in MSA patients. It is important for otolaryngologist to include MSA in the differential diagnosis of solo bilateral vocal cord abductor paralysis without any other neurological symptoms.Keywords： bilateral vocal cord abductor paralysis, multiple system atrophy(MSA), asphyxia, tracheotomy
