Tapia Syndrome, Resulting from Internal Carotid Artery Dissection in the Setting of Yoga and Review the Localization and Mechanism of Injury to the Vagal and Hypoglossal Nerves (P03.025)

Abstract

Objective: To describe a case of Tapia syndrome, resulting from internal carotid artery dissection (ICAD) in the setting of yoga. Background ICAD is an uncommon cause of stroke, accounting for 2–3% of all strokes. The absence of cerebral ischemic symptoms may lead to a delay in the diagnosis. Yoga is becoming increasingly popular. It is unclear if yoga practitioners are aware of the mechanism of ICAD. Design/Methods: Case report. Results: A sixty-eight year old gentleman with a medical history significant for GERD presented with slurred speech for five days and difficulty swallowing for 1 day. The patient had started practicing yoga, for left shoulder pain, approximately three weeks prior to admission. The yoga regimen included hyperflexion of the neck. He first noticed slurred speech along with neck discomfort five days prior to admission. This persisted without progression and on the day of admission he had sudden onset of trouble with swallowing both solid and liquid food. There were no other focal neurological symptoms noticed at this time. His general physical exam was unremarkable. His neurological exam was significant for hypophonia and dysphonia, dysarthria, dysphagia, especially with liquids, tongue deviation to the left, without atrophy or fasciculations, and a symmetric gag reflex. A left vocal cord paralysis was noticed on endoscopy. The remainder of the neurological exam was unremarkable. Magnetic resonance imaging revealed a significant decrease in flow and caliber of lumen of the cervical portion suggestive of left ICAD. Conclusions: ICAD should be considered in the differential of mononeuritis multiplex involving lower cranial nerves. ICAD can be caused by hyperflexion of the neck. Increasing awareness of the mechanism of ICAD among yoga practitioners will help avoid extreme postures involving the neck and decrease the incidence of an avoidable cause of neurologic dysfunction and stroke. Disclosure: Dr. Arcot has nothing to disclose. Dr. Liff has received personal compensation for activities with E-Rewards Medical. Dr. Horowitz has nothing to disclose.