Neurological conditions presenting as airway reflux cough

Abstract

To the Editor: The association of cough with neurological conditions is well described [1–4]. Herein, we report four patients with chronic cough who each presented to our cough clinic (Castle Hill Hospital, Cottingham, UK) with a different neurological diagnosis. Each of the patients had normal chest radiology and pulmonary function, they were not on angiotension converting enzyme inhibitors, and no obvious underlying respiratory pathology was identified. A summary of all the relevant investigations performed on each patient are detailed in table 1. View this table: Table 1. Summary of results of the four cases A 66-yr-old nonsmoking male presented with a non-productive cough for several years which was profound on rising from bed in the morning and associated with eating, but no symptoms of dyspepsia. Interestingly, he also complained of numbness over the left side of his head up to his mid upper arm. Clinical examination showed wasting of scapular muscles and biceps with absent sensations and areflexia in both lower limbs. Oesophageal pH monitoring and manometry were abnormal, with a DeMeester score of 18.3. Blood tests and cerebrospinal fluid analysis were normal. Anatomical and malignant pathology was excluded by radiological investigations. Neurophysiological studies revealed sensory polyneuropathy with a dorsal column lesion and focal radiculopathy at the right cervical (C)3, C4 and, possibly C6, levels. Autonomic testing of heart rate variability showed lack of variation of heart rate during inspiration and expiration (table 1). A diagnosis of mononeuritis multiplex was made and cough was probably secondary to vagal neuropathy causing …