Hoarseness of voice due to Vocal Cord Palsy (VCP) resulting from aortic aneurysm is a rare entity. Hoarseness due to left Recurrent Laryngeal Nerve (RLN) paralysis caused by identifiable cardiovascular disease has been described as Ortner's syndrome or Cardiovocal syndrome. Very rarely, thoracic aortic aneurysm can cause Phrenic Nerve (PN) palsy causing hemidiaphragm paralysis. But, aortic aneurysm causing both RLN and PN palsy is an extremely rare occasion. Our literature review showed only three cases of combined RLN and PN palsy due to thoracic aortic aneurysm. Here we report a 70-year-old patient having hoarseness of voice for six years for which he was on symptomatic treatment. He presented to us with cough and blood tinged sputum, left sided chest pain, loss of appetite and weakness since two months duration. Based on clinical history and chest radiograph, lung malignancy was suspected. To our surprise, Contrast Enhanced Computed Tomography (CECT) revealed partially thrombosed saccular thoracic aneurysm originating distal to origin of left subclavian artery. He was referred to the cardiothoracic vascular surgeon for surgical treatment, but was reluctant to go for surgery. He is now being followed up by cardiothoracic vascular surgery and cardiology department and his condition has remained the same.
Myelopathy due to ossification of ligamentum flavum was first described in 1938 by Anzai (J Jpn Orthop Assosc. 1938;13:305-316). This is a rare condition that has been described mostly in the far east, most commonly in Japan (Miyasaka et al, Am J Neuroradiol. 1983;4:629-632). Cases reported from the western hemisphere are rare, particularly in the African-American population (Wiseman et al, J Spinal Disord Tech. 2002;15:542-545). We report an African-American patient who presented with progressive back and chest pain of recent onset, numbness, tingling, and gait disturbance due to T3 paraplegia secondary to ossified ligamentum flavum resulting in thoracic spinal stenosis. On cross-sectional imaging, there was cord effacement at multiple levels, most pronounced at T10. The patient required emergency laminectomies, which allowed him to recover significant function. This case presentation should heighten physician awareness to this unusual clinical entity, since early diagnosis and timely surgical intervention can prevent permanent neurologic deficits.
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