Tongue paralysis after extubation

A man in his 50s experienced left-sided tongue paralysis, difficulty speaking and swallowing after a mixed drug overdose in the intensive care unit. He required respiratory support and was intubated four times, including once after removing the tube himself. Laryngoscopy showed reduced movement of the left vocal cord and pooling of saliva. Further imaging did not find a neurological cause. Tapia’s syndrome, involving paralysis of the hypoglossal and recurrent laryngeal nerves, was diagnosed. This is thought to be caused by compression or stretching of the nerves by the endotracheal tube. The patient received neurological rehabilitation but continued to have difficulty speaking and swallowing.

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