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Tapia's Syndrome

Tapia Syndrome


Presentation

  • The authors report the case of a 25-year-old man who presented with a 4-year history of progressive glossolaryngeal paralysis.[ncbi.nlm.nih.gov]
  • We present a patient with a postoperative bilateral hypoglossal and recurrent laryngeal nerves palsy after uncomplicated orotracheal intubation. Corticosteroid therapy was started after diagnosis.[ncbi.nlm.nih.gov]
  • We describe here a Brazilian female patient who presented with a lesion in the nasal mucosa, and soon after had dysphagia and dysphonia. Examination revealed paralysis of the soft palate, vocal cords and tongue ipsilaterally.[ncbi.nlm.nih.gov]
  • We herein present the case of Tapia's syndrome together with PA following open septorhinoplasty under uncomplicated endotracheal general anesthesia in a 27-year-old man.[ncbi.nlm.nih.gov]
  • We are presenting a case of a teen-ager with Tapia's syndrome who had been seeking medical assistance for episodes of loss of consciousness and was diagnosed with a high-grade peripheral B-cell lymphoma, an association not previously described.[ncbi.nlm.nih.gov]
Chronic Fatigue Syndrome
  • Kradin has a number of clinical interests including Chronic Fatigue Syndrome, Interstitial Lung Disease, Multiple Chemical Sensitivity and Pulmonary Immunology. He also holds an Associate Professor position of Pathology at Harvard Medical School.[books.google.com]
  • These include criteria for the diagnosis of multiple sclerosis, dementia of Lewy-body type, frontal lobe dementias, chronic fatigue syndrome, and inflammatory neuropathies.[books.google.de]
Hoarseness
  • Post-operatively he developed hoarseness of voice and dyspnoea during speech, with deviation of the tongue on protrusion. After excluding intracranial and surgical causes, a clinical diagnosis of Tapia's syndrome was made.[ncbi.nlm.nih.gov]
  • He complained of dysphonia, hoarseness of voice and an inability to swallow soon after extubation. The syndrome resolved completely over the following weeks with no neurological deficit.[ncbi.nlm.nih.gov]
  • On the first postoperative day, she complained left sided tongue deviation, subtle hoarseness and swallowing difficulty.[ncbi.nlm.nih.gov]
  • Speech was hoarse and dysarthric. The remainder of the cranial nerves and neurologic exam was unremarkable. MRI of brain and CSF examination were unrevealing.[neurology.org]
  • After surgery, the patient complained of hoarseness and some difficulty in swallowing the liquid diet. Four days after surgery when the intermaxillary fixation was removed, the deviation of the tongue to the left side on protrusion was found.[infona.pl]
Pneumonia
  • Description A 38-year-old man presented with influenza A (H1N1) pneumonia complicated by acute respiratory distress syndrome, resulting in an extended intensive care unit stay (37 days).[learning.doctorportal.com.au]
  • Med J Aust 2015; 202 (9): 491. doi: 10.5694/mja14.01227 Published online: 18 May 2015 A 38-year-old man presented with influenza A (H1N1) pneumonia complicated by acute respiratory distress syndrome, resulting in an extended intensive care unit stay ([mja.com.au]
Hemiatrophy of the Tongue
  • Several minor variants with many alternative eponyms include: Collet’s syndrome – from the shrapnell ball behind the right mastoid (glosso-laryngo-scapulopharyngeal paralysis) [ 2 ], Villaret’s retroparotid syndrome (‘hemiatrophy of the tongue, dysarthria[karger.com]
Neck Pain
  • At some point the patient experienced exquisite left-sided neck pain and perceived a change of sensation in his tongue. At examination he was hoarse and found to have a left Horner's Syndrome.[anesthesiology.pubs.asahq.org]
Short Arm
  • Analysis of 1 1 kindreds and linkage to the short arm of chromosome 2. J Clin Invest 1996:97: 699-705. ‏[books.google.com]
Dysarthria
  • Over the next two weeks, patient had decreased tongue deviation and improving hoarseness and dysarthria. RESULTS: MRI of the brain with and without contrast did not demonstrate any abnormalities. CSF was normal.[neurology.org]
  • Although bilateral Tapia's syndrome after general anesthesia is exceptionally rare, this complication should be recognized in patients reporting respiratory obstruction with complete dysphagia and dysarthria after prolonged intubation.[medworm.com]
  • She was then found to have severe dysarthria, which did not resolve even after 48 hours. She was noted to have complete bilateral paralysis of the tongue. Cranial nerves II–XI were intact. She had no other focal neurological deficit.[shmabstracts.com]
  • Several minor variants with many alternative eponyms include: Collet’s syndrome – from the shrapnell ball behind the right mastoid (glosso-laryngo-scapulopharyngeal paralysis) [ 2 ], Villaret’s retroparotid syndrome (‘hemiatrophy of the tongue, dysarthria[karger.com]

Workup

  • Emergency physicians often hope patients will fall into pre-existing, well-known patterns, helping them to establish the appropriate workup quickly.[medworm.com]

Treatment

  • As Tapia's syndrome is a rare and possibly devastating condition, recognition of the presence of concurrent paralyses is an important step in diagnosis and treatment.[ncbi.nlm.nih.gov]
  • We remind surgeons of this unusual complication that can occur in any surgery under general anesthesia and discuss its diagnosis, treatment method, and the followup results in light of the literature.[ncbi.nlm.nih.gov]
  • The diagnosis of an acute injury to the hypoglossal and laryngeal recurrent nerves was made and the patient was transferred to the neurology clinic for further treatment.[ncbi.nlm.nih.gov]
  • We present a patient with Tapia syndrome together with its treatment and new classification.[ncbi.nlm.nih.gov]

Prognosis

  • One case report suggests that prognosis is favorable as long as the continuity of the nerve sheath is maintained.[shmabstracts.com]

Etiology

  • The risk factors, etiology, clinical course, recovery potential, and preventive measures are analyzed and discussed.[ncbi.nlm.nih.gov]
  • (See "Fever of unknown origin in children: Evaluation" and "Fever of unknown origin in children: Etiology" .)[uptodate.com]
  • Therefore, direct compression of the hypoglossal nerve beneath the angle of the mandible, internal carotid artery dissection, and central venous catheterization may be the possible etiologies of hypoglossal nerve palsy [ 10 ].[anesth-pain-med.org]

Epidemiology

  • Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation y elaboration. PLoS Med. 2007;4(10):e297 6 da Costa BR, Cevallos M, Altman DG, Rutjes AWS, Egger M.[colombiamedica.univalle.edu.co]
  • ., Wegener, HC, and Tauxe, RV Epidemiology of Campylobacter jejuni infections in the United States and other industrialized nations.[books.google.es]
  • EPIDEMIOLOGY Periodic fever in children diagnosed with PFAPA generally begins between the ages of two and five years (3.7 3.8 years of age in the Israeli cohort of 500 patients) [ 7,9,10 ], although a younger median age of onset (11 months) was seen in[uptodate.com]
Sex distribution
Age distribution

Pathophysiology

  • Although the definitive pathophysiology is not known, a popular theory is that mechanical alteration during intubation leads to axonotmesis, thereby leading to nerve injury and presenting as paralysis.[shmabstracts.com]

Prevention

  • The risk factors, etiology, clinical course, recovery potential, and preventive measures are analyzed and discussed.[ncbi.nlm.nih.gov]
  • To avoid these disturbing complications, the mechanisms of the injury and the preventive measures should be recognized by anesthesiologists and surgeons.[ncbi.nlm.nih.gov]
  • It could be probably prevented by careful insertion of an appropriate size LMA, and the use of low intracuff pressures and/or volumes.[ncbi.nlm.nih.gov]
  • CONCLUSION: This case highlights hypoglossal and recurrent laryngeal nerve palsy occurring without direct transection during surgery, a potentially preventable complication with careful attention to reducing compression of the lateral tongue base and[neurology.org]

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