Aphonia induced by simultaneous bilateral ischemic infarctions of the putamen nuclei: a case report and review of the literature

Longitudinal MRI Evaluation of Ischemic Stroke in the Basal Ganglia of a Rhesus Macaque (Macaca mulatta) with Seizures

An adult rhesus macaque developed seizures after the induction of ischemic stroke. Initially, on the day of surgery, a focal ischemic lesion was present exclusively in the right caudate nucleus. By 48 h after stroke induction, the lesion had extended into the putamen, when a seizure was observed. Our report highlights the temporal changes in infarction of unilateral basal ganglia after acute stroke and the accompanying clinical symptoms. This unusual case may provide additional information regarding the involvement of the basal ganglia in seizures, given that prior case reports and studies usually have not described the temporal and spatial evolution of the lesion before clinical symptoms emerge.

Aphonia due to vocal cord impairment induced by carbon monoxide poisoning

Case

We describe a case of a 22-year-old woman with alteration in consciousness and aphonia due to vocal cord impairment after carbon monoxide exposure. Brain magnetic resonance imaging revealed high signal intensity in bilateral globus pallidus and the pars reticulata of the substantia nigra on T2- and diffusion-weighted images. Laryngeal fiberscopy showed bilateral immobilization of the vocal cords in median position during both inspiration and phonation. Although the effects of hyperbaric oxygen therapy remain ambiguous, these symptoms and magnetic resonance imaging findings subsided.

Outcome

Aphonia due to vocal cord impairment, as a presenting symptom of carbon monoxide poisoning, has not been previously reported. We considered the cause of aphonia was vocal cord abductor paralysis or dystonia of intralaryngeal muscles after the carbon monoxide exposure.

Conclusion

Even though aphonia is an unusual symptom in a patient with carbon monoxide poisoning, it must be taken into consideration.