Ann Rehabil Med.  2016 Feb;40(1):168-171. 10.5535/arm.2016.40.1.168.

Bilateral Cranial IX and X Nerve Palsies After Mild Traumatic Brain Injury

• Yoo SD
• Kim DH
• Lee SA
• Joo HI
• Yeo JA
• Chung SJ

• KMID: 2155180
• DOI: http://doi.org/10.5535/arm.2016.40.1.168

Abstract

We report a 57-year-old man with bilateral cranial nerve IX and X palsies who presented with severe dysphagia. After a mild head injury, the patient complained of difficult swallowing. Physical examination revealed normal tongue motion and no uvular deviation. Cervical X-ray findings were negative, but a brain computed tomography revealed a skull fracture involving bilateral jugular foramen. Laryngoscopy indicated bilateral vocal cord palsy. In a videofluoroscopic swallowing study, food residue remained in the vallecula and pyriform sinus, and there was reduced motion of the pharynx and larynx. Electromyography confirmed bilateral superior and recurrent laryngeal neuropathy.

Keyword

Basilar skull fracture; Cranial nerve diseases

MeSH Terms

Brain
Brain Injuries*
Cranial Nerve Diseases
Craniocerebral Trauma
Deglutition
Deglutition Disorders
Electromyography
Glossopharyngeal Nerve
Humans
Laryngoscopy
Larynx
Middle Aged
Paralysis*
Pharynx
Physical Examination
Pyriform Sinus
Skull Fracture, Basilar
Skull Fractures
Tongue
Vocal Cord Paralysis

Figure

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  Fig. 1 Transverse (A) and coronal (B) computed tomography revealed bilateral occipital condylar fracture (arrow) extending to the jugular foramina.

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  Fig. 2 Laryngoscopy showed incomplete movement of bilateral vocal cord.

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  Fig. 3 The videofluoroscopic swallowing study showed a large amount of vallecular residue due to absence of the swallowing reflex: (A) anteroposterior view and (B) lateral view.

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