Reversible Vagal Nerve Stimulation-Induced Vocal Cord Paralysis and Intractable Neck Pain Following a Syncopal Fall: A Case Report

TL;DR

A patient with epilepsy experienced vocal cord paralysis and neck pain after a fall, which resolved after replacing their vagal nerve stimulation system.

Contribution

This is the first reported case of symptomatic traction injury from VNS without lead displacement or vagus nerve damage.

Findings

The patient's symptoms resolved after replacing the entire VNS system.

The injury was likely due to traction without lead displacement or vagus nerve damage.

Short-term postoperative issues and lead problems are known, but this case is novel.

Abstract

Vagal nerve stimulation (VNS) is a well-tolerated procedure for patients with medication-resistant and non-focal epilepsy. It does, however, have potential complications (e.g., hoarseness and cough) thought to be from vagus nerve irritation. These arise postoperatively and generally improve without intervention. If these symptoms present later or do not improve, it suggests a more insidious etiology. Herein we report the case of a patient in their 50s with medication-resistant epilepsy, who subsequently underwent VNS electrode array and pulse generator implantation to aid seizure management. Three years after the initial implantation, the patient experienced vocal cord paralysis and neck pain following a syncopal fall. The pain radiated to their jaw and chest and was eliminated when their VNS was turned off. The patient was taken to the OR for removal and replacement of their entire VNS system. Their original electrodes were unable to be removed secondary to being scarred in place. The patient’s preoperative pain symptoms completely resolved after the removal of their old VNS and implantable pulse generator (IPG) and replacement with a new system 14 days postoperatively. While short-term postoperative sequelae and lead fractures/displacements have been reported in the literature, this is the first case to our knowledge of a patient experiencing a likely symptomatic traction injury without displacement of the VNS coils or obvious vagus nerve injury. Furthermore, the removal and replacement of the entire VNS system led to complete relief of their presenting symptoms.

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