Adult chiari malformation presenting as bilateral vocal cord paralysis

In the Chiari malformations, herniation of the cerebellar tonsils through the foramen magnum into the cervical spinal canal can often result in headaches and spinal cord deficits. Bilateral vocal cord paralysis has been reported as a result of Chiari malformation but is rare and the vast majority of reports have been in the paediatric population. We report a case in a 68-year-old man with adult Chiari malformation where aspiration pneumonia from bilateral vocal cord palsy was the only manifestation of this malformation.