[Autonomic dysfunction with nocturnal dyspnea (Gerhardt-syndrome) in a patient with multiple system atrophy].

FINDINGS: This case involves a 56-year-old man with a 3-year case history, starting with vertigo, cerebellar symptoms, followed by inspiratory stridor, especially during the night, and autonomic failure with recurrent syncopes. Magnetic resonance imaging confirmed the diagnosis of olivopontocerebellar atrophy and tilting table tests with plasma catecholamine measurement revealed an extensive drop of blood pressure with no adequate change in the heart rate or plasma catecholamine, leading to the diagnosis of multiple system atrophy (MSA). In addition, bronchoscopy revealed that the inspiratory stridor was caused by paradoxical movement of the vocal cords (sometimes known as Gerhardt's syndrome). TREATMENT AND COURSE: The patient needed a tracheotomy and treatment of the autonomic symptoms. He could be discharged in better psychic condition, without syncopes or respiratory problems.