Tapia Syndrome Caused by a Vertebral Artery Dissection

Al‐Sihan, Mutlaq; Schumacher, Martin; Löhle, E.

doi:10.1177/014556131109000709

Cited by 11 publications

(7 citation statements)

References 7 publications

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“…All, except seven of peripheral cases[9,15,29,39,40,47,51], have been attributed to orotracheal intubation for surgery or respiratory failure. The most frequently involved operations were: Osteoarticular surgery of the shoulder, mandible and cervical spine in 14 cases, otorhinolaryngology surgical procedures in 11 cases, cardiac surgery in 4 cases, thoracic surgery in 2 cases, abdominal surgery in 2 cases, and direct traumatic nerve injury in 2 cases.…”

Section: Resultsmentioning

confidence: 99%

“…There are many causes of Tapia’s syndrome, including general anaesthesia, fungal infections[44], neoplasms[2,9,14,15,24,43,45,47], vascular[29,40] and traumatic problems[1,33,50], being general anaesthesia the main cause. Intubation tube or its cuff and motion of the head during surgery can lead to injury to the pharyngeal wall and its underlying neurovascular structures (X and XII cranial nerves)[32].…”

Section: Discussionmentioning

confidence: 99%

“…But there are some reports in the literature regarding its irreversible form[43,44,46,47] or partially reversible form[16,19,22,24,29,30,39,42,48,51]. …”

Section: Discussionmentioning

confidence: 99%

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Isolated bilateral Tapia’s syndrome after liver transplantation: A case report and review of the literature

Bilbao¹,

Dopazo²,

Caralt³

et al. 2016

WJH

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AIMTo describe one case of bilateral Tapia’s syndrome in a liver transplanted patient and to review the literature.METHODSWe report a case of bilateral Tapia’s syndrome in a 50-year-old man with a history of human immunodeficiency virus and hepatitis C virus child. A liver cirrhosis and a bi-nodular hepatocellular carcinoma, who underwent liver transplantation after general anesthesia under orotracheal intubation. Uneventful extubation was performed in the intensive care unit during the following hours. On postoperative day (POD) 3, he required urgent re-laparotomy due to perihepatic hematoma complicated with respiratory gram negative bacilli infection. On POD 13, patient was extubated, but required immediate re-intubation due to severe respiratory failure. At the following day a third weaning failure occurred, requiring the performance of a percutaneous tracheostomy. Five days later, the patient was taken off mechanical ventilation and severe dysphagia, sialorrea and aphonia revealed. A computerized tomography and a magnetic resonance imaging of the head and neck excluded central nervous injury. A stroboscopy showed bilateral paralysis of vocal cords and tongue and a diagnosis of bilateral Tapia’s syndrome was performed. With conservative management, including a prompt establishment of a speech and swallowing rehabilitation program, the patient achieved full recovery within four months after liver transplantation. We carried out MEDLINE search for the term Tapia’s syndrome. The inclusion criteria had no restriction by language or year but must provide sufficient available data to exclude duplicity. We described the clinical evolution of the patients, focusing on author, year of publication, age, sex, preceding problem, history of endotracheal intubation, unilateral or bilateral presentation, diagnostic procedures, type of treatment, follow-up, and outcome.RESULTSSeveral authors mentioned the existence of around 70 cases, however only 54 fulfilled our inclusion criteria. We found only five published studies of bilateral Tapia’s syndrome. However this is the first case reported in the literature in a liver transplanted patient. Most patients were male and young and the majority of cases appeared as a complication of airway manipulation after any type of surgery, closely related to the positioning of the head during the procedure. The diagnosis was founded on a rapid suspicion, a complete head and neck neurological examination and a computed tomography and or a magnetic resonance imaging of the brain and neck to establish the origin of central or peripheral type of Tapia’s syndrome and also the nature of the lesion, ischemia, abscess formation, tumor or hemorrhage. Apart from corticosteroids and anti- inflammatory therapy, the key of the treatment was an intensive and multidisciplinary speech and swallowing rehabilitation. Most studies have emphasized that the recovery is usually completed within four to six months.CONCLUSIONTapia’s syndrome is almost always a transient complication after airway manipulation. Altho...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Isolated bilateral Tapia’s syndrome after liver transplantation: A case report and review of the literature

Bilbao¹,

Dopazo²,

Caralt³

et al. 2016

WJH

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“…In this case, marked lateral flexion may have stretched the CNs for a prolonged time or placed increased pressure around the orotracheal tube. Other pathophysiologic theories include overinflated endotracheal tube cuffs, 8 malpositioned endotracheal tubes, 6 7 carotid or vertebral artery dissection 12 14 aneurysm, 15 and increased pressure on the lateral roots of the tongue by the tongue blade during intubation. 7 9 15 All published studies report resolution of symptoms within 2 years.…”

Section: Discussionmentioning

confidence: 99%

Occam Paradox? A Variation of Tapia Syndrome and an Unreported Complication of Guidewire-Assisted Pedicle Screw Insertion

Emohare

Peterson

Slinkard

et al. 2013

Evidence-Based Spine-Care Journal

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Study Design Case report. Clinical Question The clinical aim is to report on a previously unknown association between guidewire-assisted pedicle screw insertion and neuropraxia of the recurrent laryngeal nerve (RLN), and how this may overlap with the signs of Tapia syndrome; we also report our approach to the clinical management of this patient. Methods A 17-year-old male patient with idiopathic scoliosis experienced Tapia syndrome after posterior instrumentation and arthrodesis at the level of T1–L1. After extubation, the patient had a hoarse voice and difficulty in swallowing. Imaging showed a breach in the cortex of the anterior body of T1 corresponding to the RLN on the right. Results Otolaryngological examination noted right vocal fold immobility, decreased sensation of the endolarynx, and pooling of secretions on flexible laryngoscopy that indicated right-sided cranial nerve X injury and left-sided tongue deviation. Aspiration during a modified barium swallow prompted insertion of a percutaneous endoscopic gastrostomy tube before the patient was sent home. On postoperative day 20, a barium swallow demonstrated reduced aspiration, and the patient reported complete resolution of symptoms. The feeding tube was removed, and the patient resumed a normal diet 1 month later. Tapia syndrome, or persistent unilateral laryngeal and hypoglossal paralysis, is an uncommon neuropraxia, which has previously not been observed in association with a breached vertebral body at T1 along the course of the RLN. Conclusion Tapia syndrome should be a differential diagnostic consideration whenever these symptoms persist postoperatively and spine surgeons should be aware of this as a potential complication of guidewires in spinal instrumentation.

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“…Vertebral artery dissection may cause Tapia-syndrome [ Table 1 ]. [ 45 ] Dissection of the internal carotid artery may result in dysphonia and homolateral shoulder paralysis due to palsy of the vagal and accessory nerves. [ 46 ] Horner-syndrome may be another manifestation of a carotid artery dissection, which usually is painful.…”

Section: Disorders Of Lower Cranial Nervesmentioning

confidence: 99%

Disorders of the lower cranial nerves

Finsterer

Grisold

2015

Journal of Neurosciences in Rural Practice

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Lesions of the lower cranial nerves (LCN) are due to numerous causes, which need to be differentiated to optimize management and outcome. This review aims at summarizing and discussing diseases affecting LCN. Review of publications dealing with disorders of the LCN in humans. Affection of multiple LCN is much more frequent than the affection of a single LCN. LCN may be affected solely or together with more proximal cranial nerves, with central nervous system disease, or with nonneurological disorders. LCN lesions have to be suspected if there are typical symptoms or signs attributable to a LCN. Causes of LCN lesions can be classified as genetic, vascular, traumatic, iatrogenic, infectious, immunologic, metabolic, nutritional, degenerative, or neoplastic. Treatment of LCN lesions depends on the underlying cause. An effective treatment is available in the majority of the cases, but a prerequisite for complete recovery is the prompt and correct diagnosis. LCN lesions need to be considered in case of disturbed speech, swallowing, coughing, deglutition, sensory functions, taste, or autonomic functions, neuralgic pain, dysphagia, head, pharyngeal, or neck pain, cardiac or gastrointestinal compromise, or weakness of the trapezius, sternocleidomastoid, or the tongue muscles. To correctly assess manifestations of LCN lesions, precise knowledge of the anatomy and physiology of the area is required.

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Tapia Syndrome Caused by a Vertebral Artery Dissection

Cited by 11 publications

References 7 publications

Isolated bilateral Tapia’s syndrome after liver transplantation: A case report and review of the literature

Isolated bilateral Tapia’s syndrome after liver transplantation: A case report and review of the literature

Occam Paradox? A Variation of Tapia Syndrome and an Unreported Complication of Guidewire-Assisted Pedicle Screw Insertion

Disorders of the lower cranial nerves

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