A Unique Case of Bilateral Vocal Fold Paralysis Following Spinal Anaesthesia

Abstract

Cranial nerve palsies are potential but rare complications of spinal anaesthesia. Most of the literatures support upper cranial nerve palsies like VI, IV and III cranial nerve palsies. Intrathecal hypotension resulting in tractional injury of the cranial nerves is the likely mechanism of injury. As on date, some cases of unilateral vocal fold paralysis and very little bilateral vocal fold paralysis have been described in case reports. We have described a patient who developed hoarseness and dysphagia 7 days after receiving spinal anaesthesia for fixation of inter-trochanteric fracture femur. The patient was diagnosed with bilateral vocal fold paralysis. He was managed conservatively and exhibited complete spontaneous recovery as has been described in the previously reported cases. Any patient presenting with idiopathic vocal fold paralysis should be enquired about the history of spinal or epidural anaesthesia. If the history is affirmative, then it points towards transient intrathecal hypotension as a potential etiology of the cranial nerve palsy.