# Bilateral Vocal Cord Paralysis Following a Fall: A Rare Case With a Fatal Outcome

## TL;DR

An elderly woman developed fatal bilateral vocal cord paralysis after a fall, highlighting the need for urgent airway management in such cases.

## Contribution

This case report highlights a rare and fatal outcome of bilateral vocal cord paralysis following a fall in an elderly patient.

## Key findings

- The patient developed bilateral vocal cord paralysis and atrophy after a fall-related accident.
- The case suggests cervical hyperextension injuries or cervical spur compression may cause vocal cord paralysis.
- Dysphonia after trauma should prompt concern for airway compromise due to vocal cord paralysis.

## Abstract

Bilateral vocal cord paralysis is characterized by the immobility of the vocal cord and can lead to acute respiratory distress, requiring urgent airway intervention. This article describes a rare case of bilateral vocal cord paralysis following a fall. An 87-year-old female developed dysphonia after experiencing a fall-related accident. A brain computed tomography (CT) scan revealed a 4-mm-thick left tentorium subdural hematoma, without any bone or cartilage fractures. Cervical CT demonstrated degenerative changes from C4 to C7. Fiberscope examination confirmed bilateral vocal cord paralysis and atrophy. Hours later, she experienced stridor and hypercapnia, necessitating successful intubation. Vocal cord paralysis is rarely associated with blunt head injury; however, cervical hyperextension injuries and cervical spur compression have also been reported. The two factors were also highly suspected in our case, and they may be the causes of bilateral vocal cord paralysis. To conclude, the onset of dysphonia after trauma injury should raise concern for bilateral vocal cord paralysis and prompt consideration of airway protection.