[Velopharyngeal palsy: a case report]

Here we present a case of velopharyngeal palsy. An 18-year-old man had hyperemia in his left conjunctivum. One or two weeks later he experienced nasal speech and difficulty in swallowing. General physical examination was normal. The only abnormal neurological finding was palato-pharyngeal paralysis on the right side. MRI of the head and neck had no abnormalities. Acute and convalescent sera showed no rise in viral antibody titer. CSF examination was normal except for the increased IgG% and IgG.albumin index. Treatment consisted of glycerol and steroid, and his symptom improved within two or three weeks. We think immunological mechanism is important because CSF examination showed increased IgG% and IgG.albumin index in our case. Acquired and isolated velopharyngeal palsy is uncommon. Only 26 cases have been reported so far. This is the first case in Japan. The disease has some characteristics. This occurs in childhood and adolescence. Onset is sudden, consisting in rhinolalia and dysphagia. On examination there is asymmetry of the pharynx and deviation of the uvula contralateral to the affected side. There is no other neurological abnormalities. Complete spontaneous recovery is usual. In some cases viral infection is the cause, but in most cases the cause is unknown. In contrast, the disease with both acquired velopharyngeal palsy and vocal cord palsy is relatively common. This occurs in the middle aged or elderly people. In addition to dysphagia and hoarse voice, this disease often accompanies neurological abnormalities such as other cranial nerve palsy and meningitis, fever, and pain in the pharyngeal region. In most cases viral infection is the cause.