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The prognosis of patients with ALS with severe bulbar symptoms is worse than for patients without bulbar symptoms.1 Some of these patients die suddenly and unexpectedly. Upper airway obstruction might be one of the causes. We report a patient with ALS who had recurrent trismus, stridor, and dyspnea.
Case report.
A 67-year-old woman who had bulbar ALS for 18 months was admitted to the neurologic intensive care unit (ICU) for recurrent dyspnea. The most prominent findings on admission were orthopnea with inspiratory stridor, use of the auxillary respiratory muscles, intercostal retraction, and cyanosis. She was unable to open the mouth because of spastic constriction of the masseter muscles. The temporomandibular joint was dislocated. Six liters of oxygen per minute were administered by an oxygen mask. Arterial blood gases were pathologic with a PCO2 of 46 mm Hg …
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