Bilateral Vocal Fold Paralysis After Epidural Anesthesia.

Area of Science:

• Neurology
• Anesthesiology
• Otolaryngology

Background:

• Cranial neuropathies are potential complications of spinal anesthesia, often involving upper cranial nerves.
• Intrathecal hypotension leading to cranial nerve traction is the suspected mechanism.
• Unilateral vagal neuropathy has been recently described.

Observation:

• A patient developed hoarseness and dysphagia post-childbirth epidural anesthesia.
• Videostroboscopy and laryngeal electromyography confirmed bilateral vocal fold paralysis.
• This is the first reported case of bilateral paralysis following spinal anesthesia.

Findings:

• The patient experienced complete spontaneous recovery with conservative management.
• The proposed mechanism involves dura puncture, cerebrospinal fluid egress, intracranial hypotension, and cranial nerve traction.
• All reported cases of vocal fold paralysis post-spinal anesthesia have shown spontaneous resolution.

Implications:

• Patients with idiopathic vocal fold paralysis should be screened for recent epidural or spinal anesthesia.
• Transient intrathecal hypotension may be an underrecognized cause of vocal fold paralysis.
• This highlights a rare but significant neurological complication of neuraxial anesthesia.