Vocal Fold Paralysis Following Spinal Anesthesia | Anesthesiology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Case Report/Case Series
July 2014

Vocal Fold Paralysis Following Spinal Anesthesia

Author Affiliations
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, University of Maryland School of Medicine, Baltimore
  • 2Parker Institute for Voice Disorders, Weill Cornell Medical College, New York, New York
JAMA Otolaryngol Head Neck Surg. 2014;140(7):662-663. doi:10.1001/jamaoto.2014.721
Abstract

Importance  Transient upper cranial neuropathy is a well-described complication of spinal anesthesia. Lower cranial neuropathies, in particular vagal neuropathies, have not been described. We present 4 cases of vocal fold paralysis (VFP) in 3 patients following spinal anesthesia and discuss a proposed mechanism.

Observations  Three women presented with dysphonia following spinal anesthesia and were found to have unilateral VFP. Patient 1 presented with dysphonia immediately after knee surgery. Patient 2 developed right VFP 1 week after vaginal delivery with spinal epidural anesthesia. Two years later, she presented with sudden onset of dysphonia 3 days after another vaginal delivery with spinal and epidural anesthesia; a contralateral VFP was found. Patient 3 noted dysphonia 4 days after knee surgery and was found to have left VFP. No patient had undergone intubation, and none had a central line on the side of the weakness. Imaging ruled out a relevant lesion. All 3 women had evidence of substantial recovery of motion at 6-month follow-up.

Conclusions and Relevance  Intracranial hypotension resulting in vagal neuropathy is a possible complication of spinal anesthesia and appears to be the cause of transient vocal fold palsy in these 4 cases.

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