471 - Tapia Syndrome: Paralysis of Hypoglossal and Vagus Nerves After Intubation

Case Diagnosis: Tapia Syndrome

Case Description:
A 65-year-old male with extensive vascular pathology presented to the acute care service for LVAD placement. Post-extubation, he was noted to have garbled speech secondary to tongue paralysis. He was evaluated for acute neurologic pathology, and it was determined that the etiology was Tapia Syndrome secondary to intubation. With unknown time to resolution of dysphagia, his paralysis was managed with gastrostomy tube(GT) for nutrition and medications to advance his discharge to rehabilitation facility. He was admitted to rehabilitation but was readmitted to acute care for GT replacement and abdominal wall infection, for which he was treated with broad-spectrum antibiotics. GT was removed when he passed a swallow study nine weeks after injury. Six months after injury, he continued to have poor motor control of speech, with functional communication measure (FCM) of three. Dysphagia has resolved with improved reflux management, meeting FCM goal of five.

Discussions:
Tapia Syndrome is caused by concurrent paralysis of the hypoglossal (XII) and the recurrent laryngeal branch of the vagus (X) nerve, typically unilaterally. Tapia syndrome is usually caused by intubation but can occur with other lesions or insults. Symptoms include speech and swallowing difficulties. Prognosis is extremely variable; 30% of patients achieve complete recovery, 39% of patients achieve incomplete recovery, and 26% of patients have no recovery. Recovery time also varies widely- the median time to recovery is 9-12 months with a range of 3-22 months. Our patient showed incomplete recovery in motor control of speech by six months after injury, with resolution of dysphagia by nine weeks after injury.

Conclusions:
Patients with Tapia Syndrome have variable recovery and prognosis. This report aims to demonstrate the need for prompt recognition among physiatrists to improve outcomes with earlier, tailored speech interventions.