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March 2011

Laryngospasm and “Sudden Unexpected Death Related to Medullary Brain Lesions”

Author Affiliations

Author Affiliation: London Corporation, Department of Medicine, Grand Prairie, Texas.

Arch Neurol. 2011;68(3):395-399. doi:10.1001/archneurol.2011.18

I read with interest the article by Pittock et al1 describing 9 cases of paraneoplastic jaw dystonia and laryngospasm associated with antineuronal nuclear autoantibody type 2 (anti-ri).

Of the 9 patients described,1 2 patients with breast carcinoma died of paraneoplastic brain manifestations. Patient 3 experienced “sudden death at home” following a period of recurrent laryngospasms, and “autopsy findings were consistent with asphyxiation secondary to laryngospasm.” Neuropathological examination showed significant medullary brain involvement as a component of an overall picture of chronic encephalomyelitis. Patient 4 “died unexpectedly” after persistent jaw dystonia contributing to weight loss due to poor nutrition. Autopsy was refused; however, clinical findings taken together were consistent with medullary brain involvement.

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