Background. Parsonage-Turner syndrome, or neuralgic amyotrophy (NA), is an acute brachial plexus neuritis that typically presents with unilateral shoulder pain and amyotrophy but also can affect other peripheral nerves, including the recurrent laryngeal nerve. Idiopathic vocal fold paralysis (VFP) represents approximately 12% of the VFP cases and recurrence is extremely rare. Methods and Results. We report a man with isolated recurrent unilateral right VFP and a diagnosis of NA years before. Conclusions. We emphasize that shoulder pain and amyotrophy should be inquired in any patient suffering from inexplicable dysphonia, and Parsonage-Turner syndrome should be considered in the differential diagnosis of idiopathic VFP. 1. Introduction Neuralgic amyotrophy (NA), or Parsonage-Turner syndrome, is an acute brachial plexus neuritis that typically presents with unilateral severe shoulder pain followed by patchy paresis and atrophy [1–3]. Although the pathophysiology of NA remains obscure, a predisposition for an acute immune attack towards the peripheral nerves following immunization, infections, exercise, labor, trauma, or surgery may occur [3, 4]. The incidence of 2-3 cases per 100,000 [5, 6] a year may not reflect the real figures as NA is for a certainty underdiagnosed. Idiopathic neuralgic amyotrophy (INA) is ten times more common than hereditary neuralgic amyotrophy (HNA) [4]. The prognosis is generally good, as 90% of the patients are almost fully recovered after 3 years [2]. The NA phenotype may vary to a large extent. Other segments of the peripheral nervous system (PNS) may be affected, such as the lumbosacral plexus, phrenic nerve, and the recurrent laryngeal nerve. The upper trunk of the brachial plexus is the most affected section, but involvement of single nerves, as the suprascapular, axillary, and anterior interosseus nerves, is common. The involvement of the recurrent laryngeal nerve is rare, particularly in INA [4, 7, 8]. There are only two reports of NA attacks presenting as vocal fold paralysis without pain or weakness [9, 10]. Unilateral vocal fold paralysis (VFP) is a disorder caused by dysfunction of the brainstem nuclei, the vague nerve, or the recurrent laryngeal nerve supplying the involved side of larynx. Nonlaryngeal malignancy and iatrogenic nerve injury are the major causes of unilateral VFP, while idiopathic cases correspond to approximately 12% of the patients [11]. Recent reports have shown a decrease in idiopathic cases, probably reflecting better diagnostic capabilities [12]. The symptoms of unilateral VFP are related to
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