Motor neuron disease (MND) is an umbrella term used to signify an assorted group of progressive neurologic disorders that cripple upper and lower motor neurons with axonal loss and gliosis. The MND classically presents as progressive muscle weakness, muscle atrophy, spasticity, and bulbar symptoms like dysarthria and dysphagia. The disease has a solemn course and a poor prognosis. Respiratory jeopardy is a run-of-the-mill phenomenon in this disease. It culminates from the combination of weakness of the pharyngeal and laryngeal muscles and the major respiratory muscles like diaphragm and intercostals. The upper airway flaccidity engenders the perpetuation of sleep disordered breathing (SDB) while the respiratory muscle weakness triggers lung physio-dynamic alterations and chronic respiratory failure. Hence, spirometry and polysomnography are vital tools in the diagnostic work-up. We hereby present an intriguing case of a patient with MND manifesting both these aspects of SDB and a peculiar spirometry pattern of a “two-can” effect!
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