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 language | English |
|---|---|
| Pages (from-to) | e13026 |
| Journal | Medicine |
| Volume | 97 |
| Issue number | 45 |
| DOIs | |
| Publication status | Published - Nov 2018 |
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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 journal › Article
}
TY - JOUR
T1 - Breathlessness in amyotrophic lateral sclerosis
T2 - A case report on the role of osteoporosis in the worsening of respiratory failure
AU - Portaro, Simona
AU - Morini, Elisabetta
AU - Santoro, Maria Elena
AU - Accorinti, Maria
AU - Marzullo, Pietro
AU - Naro, Antonino
AU - Calabrò, Rocco Salvatore
PY - 2018/11
Y1 - 2018/11
N2 - 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.
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.
KW - Aged, 80 and over
KW - Amyotrophic Lateral Sclerosis/complications
KW - Disease Progression
KW - Dyspnea/etiology
KW - Humans
KW - Male
KW - Osteoporosis/complications
KW - Respiratory Insufficiency/etiology
U2 - 10.1097/MD.0000000000013026
DO - 10.1097/MD.0000000000013026
M3 - Article
VL - 97
SP - e13026
JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries
JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries
SN - 0025-7974
IS - 45
ER -