ABSTRACT
OBJECTIVE: This report describes neurosyphilis presenting as vocal fold paresis and velopharyngeal incompetence. This represents the first reported case of neurosyphilis presenting as a vagal neuropathy since 1963. STUDY DESIGN: Case report. METHODS: Review of medical records and literature search. RESULTS: The patient presented with voice changes and nasopharyngeal reflux of liquids. Examination showed a left vocal fold paresis and moderate velopharyngeal incompetence. Laryngeal electromyography revealed evidence of denervation, and neurologic evaluation showed bilateral Adie's pupils and a positive CSF VDRL. A remote history of syphilis treated with one intramuscular injection was obtained. The patient was treated with 6 weeks of penicillin and regained normal vocal function with minimal residual intermittent hypernasality. CONCLUSIONS: Given the recent increase in the incidence of syphilis in the United States, this case serves as a reminder of the importance of including syphilis in the differential diagnosis of cranial neuropathies and the increasing likelihood of syphilis presenting to otolaryngology and speech pathology practices. Syphilis, a disease whose incidence had declined progressively for 60 years in the United States, is now resurgent and must be considered in the evaluation of patients presenting with unexplained cranial neuropathies.
Subject(s)
Neurosyphilis/complications , Vagus Nerve/physiopathology , Velopharyngeal Insufficiency/etiology , Vocal Cord Paralysis/etiology , Adult , Anti-Bacterial Agents/administration & dosage , Diagnosis, Differential , Drug Administration Schedule , Electromyography , Humans , Male , Neurologic Examination , Neurosyphilis/diagnosis , Neurosyphilis/drug therapy , Neurosyphilis/physiopathology , Penicillin G Benzathine/administration & dosage , Predictive Value of Tests , Recurrence , Time Factors , Treatment Outcome , Velopharyngeal Insufficiency/diagnosis , Velopharyngeal Insufficiency/drug therapy , Velopharyngeal Insufficiency/physiopathology , Vocal Cord Paralysis/diagnosis , Vocal Cord Paralysis/drug therapy , Vocal Cord Paralysis/physiopathologyABSTRACT
A unique case of acute onset vocal fold paralysis secondary to phonotrauma is presented. The cause was forceful vocalization by a drill instructor on a firearm range. Imaging studies revealed extensive intralaryngeal and retropharyngeal hemorrhage. Laryngoscopy showed a complete left vocal fold paralysis. Relative voice rest was recommended, and the patient regained normal vocal fold mobility and function after approximately 12 weeks.
