Head injury patient with bilateral vocal cord paralysis: a mistake and a lesson learnt

Abstract

Bilateral recurrent nerve palsy along with head injury is a rare clinical possibility and can be potentially fatal if not properly diagnosed. We report a case of a head injury patient with intact Glasgow Coma Scale requiring immediate re-intubation and tracheostomy after extubation failure as a result of stridor and severe dyspnoea with paradoxical respiratory pattern, possibly because of undiagnosed significant surgical history.

Transient bilateral vocal fold paralysis after total thyroidectomy

“…Regarded as the rarest among all complications post-thyroidectomy, the reported incidence is 0.7%, with it being permanent in 0.3%. [3] The devastating effect is primarily due to the need for a tracheostomy and the loss of normal speech. Perplexed, we opted to wait for 24 hours and attempt another trial of extubation before converting to a tracheostomy, as we could think of no problems with our surgery.…”

Laryngeal Paralysis Recovered Two Years After a Head Trauma by Growth Hormone Treatment and Neurorehabilitation

“…In traumatic causes, a plausible explanation for lower cranial nerve deficits after jugular foramen fracture was that some cranial nerves were directly compressed by displaced bone fragments [7], or due to dense ossification [8]. Recurrent bilateral nerve palsy after head injury is a rare clinical possibility, but can be life-threatening if not diagnosed correctly [9]. Vascular events involving, for example, the posteroinferior cerebellar artery leading to occlusion, may involve the nucleus ambiguus on the dorsolateral area of the bulb, leading to loss of motoneurons in this zone.…”