Neuroradiologic findings in infants and children with vocal cord paralysis

Purpose: In the pediatric population, central neurologic etiologies of vocal cord paralysis (VCP) are encountered commonly. The purpose of this study is to delineate the frequency and nature of central nervous system abnormalities shown by modern imaging modalities in children with VCP. Methods: This study evaluated the clinical records (n = 19), computed tomographic (CT) studies (n = 13), and magnetic resonance imaging (MRI) studies (n = 13) of 22 pediatric patients with unilateral or bilateral VCP. Patient age ranged from newborn to 17 years, but most of the children were examined during the first year of life. In each case, prior evaluation had not demonstrated an extracranial cause of VCP. Results: Results of imaging findings included normal (n = 7), Chiari II malformation (n = 7), intracranial hemorrhage (n = 3), migrational disorders (n = 2), primary microcephaly (n = 1), pontine hypoplasia (n = 1), cerebellar atrophy (n = 1), and Chiari I malformation (n = 1). The absence of abnormal findings on imaging studies tended to correlate with a good clinical outcome. Conclusion: The central neuroanatomy of vocal cord innervation is complex, with contributions arising from the cerebral cortex, the cerebellum, and the brainstem. Therefore, imaging evaluation of a child with unexplained VCP should include a thorough study of these regions, including attention to the cerebral cortex for possible migrational anomalies.