Background Tapia’s syndrome is very rare and manifests from concurrent recurrent laryngeal nerve and hypoglossal nerve palsies, often following general anaesthesia. It is commonly characterised as dysphonia, tongue dysmotility with dysarthria and dysphagia. This usually presents after orotracheal intubation and the mechanism of injury is thought to occur from over stretching of both the vagal and hypoglossal nerves at either the transverse process of the first cervical vertebra, or over the wall of the pharynx. Typically the deficit is temporary with anticipated full recovery. Diagnosis is clinical and requires exclusion of central causes with imaging, which includes contrast CT and MRI. A multidisciplinary approach is essential and treatment is supportive. Around one-third of the patients will achieve full resolution.
Case report A case of a 60 year old man is described, who suffered intraoperative complication and required emergency coronary artery bypass graft surgery after an elective angiogram. He was diagnosed with Tapia’s syndrome 3 weeks post-operatively, when he was found to have left sided tongue atrophy, and bilateral vocal cord palsy after extubation. No other neurological features were noted and further imaging did not reveal any central causes for vocal cord palsy. He was discharged home after a gradual improvement with supportive therapy that included a tracheostomy insertion.
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