1411 - Velopharyngeal Insufficiency in the Setting of Thalamic Infarct

Case Diagnosis: Velopharyngeal insufficiency (VPI), also known as velopharyngeal dysfunction (VPD), refers to sphincter dysfunction of the intermediary between nasal and oral cavities. VPI is most seen in the setting of anatomical abnormalities such as in cleft lip/palate. We present a patient with VPD and unilateral vocal cord paralysis in association with a thalamic infarct.

Case Description: A 43-year-old male with past medical history of hypertension, hyperlipidemia, and type II diabetes with a left thalamic lacunar infarct. The patient presented with common deficits associated with thalamic infarcts (dysphagia) as well as, left unilateral vocal cord paralysis and VPD diagnosed on the premise of hypernasal speech.



The patient was evaluated for hypernasal speech by speech therapy. A flexible laryngoscopy was also performed. Both evaluations revealed soft palate dysfunction and flexible laryngoscopy revealed left vocal cord paralysis. Despite new onset palate dysfunction and vocal cord paralysis, patient could maintain his airway, and never required intubation.

Discussions: VPD is an extremely rare complication of cerebral infarct. While speech changes are common in the setting of stroke, hypernasal speech, difficulty blowing, and whistling are more specific to VPD. Difficulties with these specific functions, ultimately suggests pressure dysfunction through air escape. The sphincter is ultimately required for optimal swallowing and speaking functions. Hypernasal speech, can be an indicator for possible VPI in the setting of cerebral infarct.

Conclusions: The association between VPD and cerebral infarct is rare. Despite speech changes associated with cerebral infarcts, hypernasal speech serves as a possible indicator of VPI. More research is needed to explore the incidence of VPD in the setting of cerebral infarct.