Breathlessness in amyotrophic lateral sclerosis

A case report on the role of osteoporosis in the worsening of respiratory failure

Simona Portaro, Elisabetta Morini, Maria Elena Santoro, Maria Accorinti, Pietro Marzullo, Antonino Naro, Rocco Salvatore Calabrò

Research output: Contribution to journalArticle

Abstract

RATIONALE: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative multisystem disorder, presenting with limb or bulbar onset. To date, there is no cure for ALS. At some stage of the disease, patients may complain of breathlessness due to respiratory failure, thus needing a noninvasive mechanical ventilation (NIMV) support. However, breathlessness is a symptom that may be induced by different causes that must be taken into consideration in ALS management.

PATIENTS CONCERNS: We report the case of an 81-year-old man, with a spinal onset ALS, who was admitted to our clinic to start NIMV because of respiratory involvement. After 3 weeks from NIMV performed at night time, with beneficial effects, he suddenly complained of breathlessness even at rest and in standing position.

DIAGNOSIS: Respiratory and cardiac assessments did not show new clinical events, indicating the worsening respiratory function. Due to a history of osteoporosis which was treated with biphosphonates and even though no previous bone trauma or falls were reported, we performed a spine computed tomography scan. The findings indicated multiple dorsal vertebral fractures which was a probable cause for breathlessness.

INTERVENTIONS AND OUTCOMES: Considering the neurodegenerative disease associated to respiratory failure, the cardiovascular risk factors and the age, the patient refused to undergo a surgery with kyphoplasty. A spine support was then prescribed, together with analgesic medications, with significant alleviation of pain and breathlessness.

LESSONS: The occurrence of breathlessness in a patient with ALS cannot always be related to the bulbar involvement. Other causes should be taken into account, especially when there is sudden worsening of symptoms in spite of good clinical response and compliance to NIMV treatment.

Original languageEnglish
Pages (from-to)e13026
JournalMedicine
Volume97
Issue number45
DOIs
Publication statusPublished - Nov 2018

Fingerprint

Amyotrophic Lateral Sclerosis
Respiratory Insufficiency
Dyspnea
Osteoporosis
Noninvasive Ventilation
Artificial Respiration
Neurodegenerative Diseases
Spine
Kyphoplasty
Posture
Analgesics
Extremities
Tomography
Bone and Bones
Pain
Wounds and Injuries

Keywords

  • Aged, 80 and over
  • Amyotrophic Lateral Sclerosis/complications
  • Disease Progression
  • Dyspnea/etiology
  • Humans
  • Male
  • Osteoporosis/complications
  • Respiratory Insufficiency/etiology

Cite this

Breathlessness in amyotrophic lateral sclerosis : A case report on the role of osteoporosis in the worsening of respiratory failure. / Portaro, Simona; Morini, Elisabetta; Santoro, Maria Elena; Accorinti, Maria; Marzullo, Pietro; Naro, Antonino; Calabrò, Rocco Salvatore.

In: Medicine, Vol. 97, No. 45, 11.2018, p. e13026.

Research output: Contribution to journalArticle

Portaro, Simona ; Morini, Elisabetta ; Santoro, Maria Elena ; Accorinti, Maria ; Marzullo, Pietro ; Naro, Antonino ; Calabrò, Rocco Salvatore. / Breathlessness in amyotrophic lateral sclerosis : A case report on the role of osteoporosis in the worsening of respiratory failure. In: Medicine. 2018 ; Vol. 97, No. 45. pp. e13026.
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AB - RATIONALE: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative multisystem disorder, presenting with limb or bulbar onset. To date, there is no cure for ALS. At some stage of the disease, patients may complain of breathlessness due to respiratory failure, thus needing a noninvasive mechanical ventilation (NIMV) support. However, breathlessness is a symptom that may be induced by different causes that must be taken into consideration in ALS management.PATIENTS CONCERNS: We report the case of an 81-year-old man, with a spinal onset ALS, who was admitted to our clinic to start NIMV because of respiratory involvement. After 3 weeks from NIMV performed at night time, with beneficial effects, he suddenly complained of breathlessness even at rest and in standing position.DIAGNOSIS: Respiratory and cardiac assessments did not show new clinical events, indicating the worsening respiratory function. Due to a history of osteoporosis which was treated with biphosphonates and even though no previous bone trauma or falls were reported, we performed a spine computed tomography scan. The findings indicated multiple dorsal vertebral fractures which was a probable cause for breathlessness.INTERVENTIONS AND OUTCOMES: Considering the neurodegenerative disease associated to respiratory failure, the cardiovascular risk factors and the age, the patient refused to undergo a surgery with kyphoplasty. A spine support was then prescribed, together with analgesic medications, with significant alleviation of pain and breathlessness.LESSONS: The occurrence of breathlessness in a patient with ALS cannot always be related to the bulbar involvement. Other causes should be taken into account, especially when there is sudden worsening of symptoms in spite of good clinical response and compliance to NIMV treatment.

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SN - 0025-7974

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