Unilateral Vocal Cord Paralysis associated with Ipsilateral Acute Cortical Stroke: A Rare Case Presentation (P3.254)

Objective: NA Background: Vocal cords are innervated by the recurrent laryngeal nerve and superior laryngeal nerve which are branches of the vagus nerve. Nucleus ambiguous is the motor nucleus of the vagus nerve and it is located in the medulla. It receives stimuli from the cerebral cortex from both sides of the brain through the corticobulbar tracts. Design/Methods: A case report of a sixty-two-year-old female patient with a significant past medical history of hypertension and obesity presented with sudden onset right-sided weakness and aphasia. A brain CT-scan showed no bleeding but she was out of the window for thrombolytic therapy. MRI brain showed complete left middle cerebral artery occlusion and CTA head showed left ICA long segment occlusion right after bifurcation. Patient improved during the course of her stay and she was able to pronounce few words, however, she expressed severe hypophonia. Otolaryngology was consulted for vocal cords evaluation. Results: Patient underwent Flexible fiberoptic laryngoscopy which showed significantly paralyzed left vocal cord in a paramedian position. The right cord was fully mobile with intact glottic opening. There were no procedures performed that can explain any injury to the recurrent laryngeal nerve as well as no clear lesions or masses on imaging that would explain her symptoms. Conclusions: Injury to the motor cortex rarely causes unilateral vocal cord paralysis since vagus nerve nucleus receives cortical fibers from the corticobulbar tract bilaterally. A previous prospective study of 54 patients reported the incidence of unilateral vocal cord paralysis following acute ischemic stroke contralateral to the paralyzed vocal cord. The finding questioned the bilateral innervation of nucleus ambiguous by motor cortex. We present the first case of unilateral vocal cord paralysis ipsilateral to the cortical brain lesion. Disclosure: Dr. Sawalha has nothing to disclose. Dr. Hussein has nothing to disclose. Dr. Abd-Elazim has nothing to disclose. Dr. Greene-Chandos has nothing to disclose. Dr. Torbey has nothing to disclose.