{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T12:06:10Z","timestamp":1784289970210,"version":"3.55.0"},"reference-count":26,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,5]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>\n                    We present the case of a man in his 40s with Miller Fisher\/Guillain-Barr\u00e9 overlap syndrome complicated by bilateral vocal cord (BVC) paralysis and respiratory failure. MRI, nerve conduction studies confirming motor-predominant axonal loss, and positive anti-GD1b and GM1 antibodies supported the diagnosis. Emergency intubation and tracheostomy for ventilatory weaning was required. Persistent BVC immobility despite peripheral neurological recovery prevented decannulation and prompted further evaluation. Laryngeal electromyography (LEMG) revealed BVC denervation and reinnervation suggesting neurological recovery and mechanical fixation as the likely cause of persistent BVC immobility. Intraoperative findings confirmed a type 1 Bogdasarian posterior glottic stenosis. Voice-preserving microlaryngoscopic surgery with CO\n                    <jats:sub>2<\/jats:sub>\n                    laser scar excision, balloon dilation and steroid injection improved airway patency and led to successful tracheostomy decannulation. This case highlights the importance of recognising both neuropathic and mechanical causes of persistent BVC immobility following neurological injury and intubation, the value of multidisciplinary management and LEMG in guiding diagnosis and treatment.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2026-273061","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:40:15Z","timestamp":1784288415000},"page":"e273061","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Vocal cord immobility in Guillain-Barr\u00e9 syndrome: a diagnostic challenge"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6966-1058","authenticated-orcid":false,"given":"Alex","family":"Penfold","sequence":"first","affiliation":[{"name":"ENT, Guy's and St Thomas\u2019 Hospitals NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Haymes","sequence":"additional","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust, London, UK"},{"name":"Guy's and St Thomas\u2019 Hospitals NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ad\u00e8le","family":"Evans-Tomlinson","sequence":"additional","affiliation":[{"name":"Royal Hospital for Neuro-disability, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yakubu","family":"Karagama","sequence":"additional","affiliation":[{"name":"ENT, Guy's and St Thomas\u2019 Hospitals NHS Trust, London, UK"},{"name":"King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"2026071704400858000_19.7.e273061.1","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2023.1250774","article-title":"Miller Fisher syndrome: an updated narrative review","volume":"14","author":"Noioso","year":"2023","journal-title":"Front Neurol"},{"key":"2026071704400858000_19.7.e273061.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM195607122550201"},{"key":"2026071704400858000_19.7.e273061.3","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/MEJ.0b013e3280bef955","article-title":"Miller Fisher variant syndrome, an unusual and severe clinical presentation: a case report","volume":"14","author":"G\u00e9rard","year":"2007","journal-title":"Eur J Emerg Med"},{"key":"2026071704400858000_19.7.e273061.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2010.06.003"},{"key":"2026071704400858000_19.7.e273061.5","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1177\/01945998221120005","article-title":"Posterior Glottic Injury Following Prolonged Intubation in COVID-19 Patients","volume":"168","author":"So","year":"2023","journal-title":"Otolaryngol Head Neck Surg"},{"key":"2026071704400858000_19.7.e273061.6","unstructured":"Rocha Cabrero F , Morrison EH . Miller Fisher Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/"},{"key":"2026071704400858000_19.7.e273061.7","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.43.10.1911"},{"key":"2026071704400858000_19.7.e273061.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-8993(96)01123-7"},{"key":"2026071704400858000_19.7.e273061.9","first-page":"57","article-title":"The Miller Fisher syndrome. 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