Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore.
Parker Institute for Voice Disorders, Weill Cornell Medical College, New York, New York.
JAMA Otolaryngol Head Neck Surg. 2014 Jul;140(7):662-3. doi: 10.1001/jamaoto.2014.721.
Transient upper cranial neuropathy is a well-described complication of spinal anesthesia. Lower cranial neuropathies, in particular vagal neuropathies, have not been described. We present 4 cases of vocal fold paralysis (VFP) in 3 patients following spinal anesthesia and discuss a proposed mechanism.
Three women presented with dysphonia following spinal anesthesia and were found to have unilateral VFP. Patient 1 presented with dysphonia immediately after knee surgery. Patient 2 developed right VFP 1 week after vaginal delivery with spinal epidural anesthesia. Two years later, she presented with sudden onset of dysphonia 3 days after another vaginal delivery with spinal and epidural anesthesia; a contralateral VFP was found. Patient 3 noted dysphonia 4 days after knee surgery and was found to have left VFP. No patient had undergone intubation, and none had a central line on the side of the weakness. Imaging ruled out a relevant lesion. All 3 women had evidence of substantial recovery of motion at 6-month follow-up.
Intracranial hypotension resulting in vagal neuropathy is a possible complication of spinal anesthesia and appears to be the cause of transient vocal fold palsy in these 4 cases.
短暂性颅神经病变是脊髓麻醉的一种常见并发症。颅神经病变，特别是迷走神经病变，尚未被描述。我们报告了 3 名患者在脊髓麻醉后出现 4 例声带麻痹（VFP）病例，并讨论了一种假设的机制。
3 名女性在脊髓麻醉后出现声音嘶哑，并被发现单侧 VFP。患者 1 在膝关节手术后立即出现声音嘶哑。患者 2 在脊髓硬膜外麻醉后 1 周出现右侧 VFP，两年后，她在另一次脊髓和硬膜外麻醉的阴道分娩后 3 天突然出现声音嘶哑，发现对侧 VFP。患者 3 在膝关节手术后 4 天出现声音嘶哑，发现左侧 VFP。没有患者进行过插管，也没有患者在虚弱侧有中央导管。影像学检查排除了相关病变。所有 3 名女性在 6 个月随访时均有明显运动功能恢复的证据。
颅内压降低导致迷走神经病变可能是脊髓麻醉的一种并发症，似乎是这 4 例患者短暂性声带麻痹的原因。
