Cases reported "Hoarseness"

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1/39. Painless aortic dissection presenting as hoarseness of voice: cardiovocal syndrome: Ortner's syndrome.

    Most of the neurological manifestations of the aortic dissection are due to neuronal ischemia secondary to either extension of the dissection process into a branch artery, or compression of an artery by the false lumen of the dissecting aortic hematoma. However, the enlarging false lumen may directly compress on an adjacent nerve, causing neuronal injury resulting in neurological symptoms. This may particularly take place when a distal intimal tear does not decompress the false lumen, resulting in formation of an expanding blind pouch. About 10% of aortic dissections are painless and may present with symptoms secondary to the complications of the dissection. Although cardiovocal syndrome, or Ortner's syndrome (hoarseness of voice due to involvement of recurrent laryngeal nerve in cardiovascular diseases) has been described with aortic dissection, it has not been reported as an initial presenting feature of this disorder. This report describes the first case of painless aortic dissection presenting with hoarseness of voice, the cardiovocal syndrome. The hoarseness remained the only symptom throughout the entire course of the disease. The aortic dissection was not suspected initially. During surgical exploration, the recurrent laryngeal nerve was found compressed by the false lumen at the level of aortic arch. Aortic root replacement was performed successfully, resulting in complete resolution of the hoarseness. The neurological manifestations of aortic dissection, and the cardiovocal syndrome, are discussed.
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2/39. A benign parathyroid cyst presenting with hoarse voice.

    Parathyroid tumours and cysts are rare and, when presenting as neck masses, can be clinically misdiagnosed as thyroid lesions. Symptoms may be caused by compression of the surrounding structures or hormonal overactivity. This paper describes a patient with recurrent hoarseness owing to the pressure effects of a parathyroid cyst on the recurrent laryngeal nerve.
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3/39. Vagal schwannoma of the cerebello-medullary cistern presenting with hoarseness and intractable tinnitus: a rare case of intra-operative bradycardia and cardiac asystole.

    Schwannomas arising from the lower cranial nerves (IX-XI) are rare, constituting only 3% of all intracranial schwannomas unassociated with neurofibromatosis. A great majority of these tumours present as jugular foramen lesions and less commonly they occur along the extracranial course of these nerves. An intracisternal location is extremely rare. We report a case of vagal schwannoma purely in the cerebello-medullary cistern causing distortion of the medulla oblongata. Total microsurgical excision of this tumor, arising from one of the rootlets of the vagus nerve, was achieved with preservation of the 9th, 10th and 11th cranial nerves.The intraoperative course was complicated by two episodes of complete cardiac asystole, each lasting for 4(s), and six episodes of severe bradycardia. The patient was relieved of his intractable tinnitus but continued to have a hoarse voice due to an ipsilateral partial vocal cord palsy.
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4/39. Self-inflicted vocal cord paralysis in patients with vagus nerve stimulators. Report of two cases.

    vagus nerve stimulation for treatment of epilepsy is considered safe; reports of severe complications are rare. The authors report on two developmentally disabled patients who experienced vocal cord paralysis weeks after placement of a vagus nerve stimulator. In both cases, traction injury to the vagus nerve resulting in vocal cord paralysis was caused by rotation of the pulse generator at the subclavicular pocket by the patient. Traumatic vagus nerve injury caused by patients tampering with their device has never been reported and may be analogous to a similar phenomenon reported for cardiac pacemakers in the literature. As the use of vagus nerve stimulation becomes widespread it is important to consider the potential for this adverse event.
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5/39. Mesenchymal chondrosarcoma of the vagus nerve.

    Mesenchymal chondrosarcoma is a rare, aggressive, malignant neoplasm, which arises from extraskeletal sites in 30-40 per cent of cases. It is extremely rare in children. We present a novel case of childhood mesenchymal chondsarcoma arising from the vagus nerve in the neck, resulting in paralysis of the right vocal fold. The clinicopathologic features and management of this case are described along with a brief discussion on the aetiology of vocal fold paralysis in this age group. Current literature on extraskeletal presentation of mesenchymal chondrosarcoma is reviewed.
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6/39. Delayed onset of vocal cord paralysis after explantation of a vagus nerve stimulator in a child.

    INTRODUCTION: vagus nerve stimulation for the management of intractable seizure disorders is increasingly being used, especially in younger children. Although complications such as infection or vocal cord paralysis are uncommon, some may be unreported. CLINICAL PRESENTATION: A 3.5-year-old boy with intractable complex partial and generalized seizures had a left vagus nerve stimulator (VNS) successfully implanted. Two weeks later, the cervical incision showed signs of infection, antibiotics were started, and the VNS generator and leads were explanted. Three weeks later the child's mother noted a change in the voice of her son, as well as increased coughing and gagging. Flexible laryngoscopy identified a left vocal cord paralysis, which eventually resolved after 6 months. CONCLUSION: infection requiring explantation of a VNS is uncommon. The risk is higher in younger children, especially in those who are developmentally delayed. These children may continuously drool, with saliva or food soiling the fresh incision, or even pick at the incision to the point of twisting or even pulling out the electrodes. Less common is a vocal cord paralysis, especially occurring in a delayed fashion.
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7/39. hoarseness after laryngeal blunt trauma: a differential diagnosis between an injury to the external branch of the superior laryngeal nerve and an arytenoid subluxation. A case report and literature review.

    Arytenoid subluxation is a well-known cause of hoarseness due to incomplete glottic closure with intact inferior laryngeal nerves after severe laryngeal trauma. We report the case of a young man presenting after laryngeal blunt trauma with hoarseness, easy fatigue during phonation, marked difficulty with his high-pitch and singing voice and decreased phonation time, but intact function of both inferior laryngeal nerves, intact endolaryngeal mucosa sensibility and normal CT scans of the larynx and the neck. Due to the asymmetric anteromedial position of the right arytenoid with incomplete glottic closure, the primary diagnosis was arytenoid subluxation, and the patient was referred for instantaneous relocation therapy. The stroboscopic and electromyographic diagnosis of a unilateral paresis of the external branch of the right superior laryngeal nerve caused the therapy to be changed. Without repositioning, the patient had a total recovery of voice quality when the paresis receded 2 months later. In conclusion, the unilateral paresis of the external branch of the superior laryngeal nerve after laryngeal blunt trauma is reported here for the first time. Although the clinical findings are familiar sequelae of thyroid surgery, they may be misdiagnosed as arytenoid subluxation after laryngeal blunt trauma. stroboscopy and electromyography permitted the correct diagnosis.
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8/39. hoarseness after pulmonary arterial stenting and occlusion of the arterial duct.

    We report a 12-year-old girl who had multiple congenital cardiac lesions, specifically an arterial duct, left pulmonary arterial stenosis, an atrial septal defect in the oval fossa, and mild Ebstein's malformation of the tricuspid valve. Therapeutic transcatheter intervention was performed to stent the left pulmonary artery, occlude the arterial duct with a coil, and place a device to close the atrial septal defect. Subsequent to the catheterization, she complained of hoarseness, which was shown to be due to entrapment of the left recurrent laryngeal nerve between the coil used to close the arterial duct and the stent placed in the left pulmonary artery. laryngoscopy confirmed paralysis of the recurrent laryngeal nerve.
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9/39. Cardiovocal (Ortner's) syndrome left recurrent laryngeal nerve palsy associated with cardiovascular disease.

    Five patients with cardiovascular disease presented with hoarseness due to left recurrent laryngeal nerve palsy. One had secundum atrial septal defect, one had ventricular septal defect, two had mitral stenosis and the other had aortic aneurysm. All except the patient with aortic aneurysm had pulmonary artery dilatation and moderate to severe pulmonary hypertension. Four patients' hoarseness resolved after successful interventional therapy. As for the patient with the aortic aneurysm, hoarseness persisted; the patient died before surgery. We postulate that the dilated pulmonary artery or aortic arch was responsible for the compression of the left recurrent laryngeal nerve.
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10/39. Sudden hoarseness due to unilateral cord vocal paralysis in a patient with Behcet's disease.

    Behcet's disease is a systemic necrotising vasculitis affecting arteries and veins of all sizes in any location [1]. Here we report a patient with Behcet's disease who presented with sudden hoarseness due to unilateral vocal cord paralysis from recurrent laryngeal nerve damage.
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