Vocal cord paresis on CTA - A novel tool for the diagnosis of lateral medullary syndrome

Shlomi Peretz, Shira Rosenblat, Michal Zuckerman, Edna Inbar, Hagit Shoffel-Havakuk, Rani Barnea, Israel Steiner, Tzippy Shochat, Eitan Auriel, Dror Suhami

Research output: Contribution to journalArticlepeer-review


Background: Diagnosis of lateral medullary syndrome (LMS) is often delayed due to elusive clinical presentations and frequently non-revealing neuroimaging tests. We aimed to investigate the use of ipsilateral vocal cord paresis (VCP) identified on neck computed tomography angiography (CTA) as an early diagnostic sign for LMS. Methods: Medical records were queried for patients admitted with LMS between 1/2012 and 10/2020. A control group of patients undergoing CTA for transient or no neurological symptoms was matched for sex and age. Clinical data were collected by a stroke neurologist. Two neuroradiologists independently and blindly assessed CTA images for radiological signs of VCP. Results: Fifteen LMS and 15 control patients were included in the analysis. Median time from arrival to LMS diagnosis was 29.4 h [IQR 7,47] and twice as long in patients who suffered aspiration pneumonia. Thrombolysis rate was 0% in LMS patients versus 14.5% in general stroke patients. Dysphonia was noted in the emergency department in three (20%) patients, whereas all 15 patients had radiological signs of VCP on CTA. Medialization of a true vocal cord was the most sensitive (100%) and specific (80–87%) sign for LMS, with good inter-rater agreement (kappa 0.66). Timely detection of VCP on CTA could have shortened median time to LMS diagnosis by 14 h and enabled thrombolytic therapy in 3 (20%) patients. Conclusions: VCP on CTA is a valuable sign for the diagnosis of LMS. If detected early, it may enable reperfusion therapy and prevent aspiration pneumonia, consequently saving life and diminishing disability.

Original languageEnglish
Article number117576
JournalJournal of the Neurological Sciences
StatePublished - 15 Oct 2021


  • CTA
  • Stroke
  • Wallenberg


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