Transient vocal cord paralysis after transverse Sinus stenting

Area of Science:

• Neurology
• Interventional Neuroradiology

Background:

• Idiopathic intracranial hypertension (IIH) is a condition of elevated intracranial pressure without a clear cause.
• Transverse sinus stenting (TSS) is a treatment option for IIH when pharmacologic management fails or is not tolerated.

Discussion:

• This case highlights a rare complication of TSS: transient palsies of the 10th and 11th cranial nerves.
• The symptoms were likely caused by compression of the glossopharyngeal and vagus nerves within the jugular foramen by the stent delivery system.
• Diagnostic workup, including orotracheal examination and MRI, excluded other structural or brainstem pathologies.

Key Insights:

• Transverse sinus stenting can lead to temporary cranial nerve deficits.
• Nerve compression at the jugular foramen is a plausible mechanism for these deficits.
• Spontaneous resolution of symptoms is expected within weeks to months.

Outlook:

• Further investigation into the precise mechanisms of nerve injury during TSS is warranted.
• Awareness of this potential complication can aid in patient counseling and management.
• Optimizing stent delivery techniques may mitigate the risk of cranial nerve palsies.