Spasmodic croup (laryngismus stridulus)

• occurs at night
• clinical picture similar to that of viral croup.
• symptoms begin suddenly and are characterized by a sudden onset of
  • dyspnea
  • barklike cough
  • stridor in a previously healthy child. (note that viral croup presents with a prodrome)
  • NO FEVER
• Spasmodic croup usually resolves quickly with exposure to humidified air, only to recur for the next few days.
• Subglottic noninflammatory edema and, in some cases, spasm of the glottis with closure of the crowded aryepiglottic folds characterize spasmodic croup.
• Fiberoptic laryngoscopy
  • In spasmodic croup: inflamed mucosa, erythematous and with a velvety appearance.
  • In viral croup: a pale and boggy laryngeal mucosa.
  • In bacterial tracheitis: abundant purulent exudate and pseudomembranes.

Emedicine Sept 2004