Bilateral vocal cord paralysis with acute ischemic stroke

Abstract

Vocal cords receive nerve supply from recurrent laryngeal nerve which is a branch of the vagus nerve. Cerebral motor cortex projects corticobulbar tracts to the motor nucleus (nucleus ambiguous) of the vagus found in medulla. Vagus nerve leaves the skull through jugular foramen and travels through the carotid sheath. The left vagus gives rise to left recurrent laryngeal nerve at the aortic arch, whereas the right vagus gives rise to right recurrent laryngeal nerve at the subclavian artery. Any disruption of this pathway by any entity will cause unilateral vocal cord paralysis. Strokes that affect the motor cortex do not cause unilateral vocal cord paralysis since vagus nerve nucleus receives corticobulbar tract from both sides of the brain. We present an unusual case of bilateral vocal cord paralysis caused by unilateral right insular stroke which is not related to this pathway.

Parálisis bilateral de las cuerdas vocales con obstrucción aguda de la vía aérea y traqueotomía urgente en una paciente con ictus vertebrobasilar agudo

“…El ictus vertebrobasilar asociado a PCV bilateral se ha descrito en el contexto de afectación bilateral del troncoencéfalo [ 3 , 4 ]. Por otro lado, se han descrito varios casos de PCV bilateral en el contexto de un ictus isquémico supratentorial, que suele afectar al territorio dependiente de la arteria cerebral media, incluida la ínsula [ 5 , 6 ]. Algunos de ellos postulan que un centro cortical de control bilateral de las cuerdas vocales conectado al nervio vago podría estar situado en la corteza insular.…”