Tapia syndrome

Tapia syndrome

CN X & XII palsy (± XI)

AKA Matador’s disease (first described in a bullfighter by Antonio Garcia Tapia) 1). Some authors describe an intracranial and extracranial form.

Etiology

Tapia syndrome, a rare complication of posterior cervical surgery, characterized by concurrent paralyzes of the recurrent laryngeal branch of the vagus and hypoglossal cranial nerves, occurred in a patient after posterior cervical foraminotomies for radiculopathy 2).

Etiologies include oral intubation (the majority of cases prior to 2013), metastases, rarely associated with carotid or vertebral artery dissections.

Symptoms

Hoarseness of voice, dysphagia secondary to incoordination of the tongue and food bolus propulsion, unilateral atrophy and paralysis of the tongue, ± paralysis of sternocleidomastoid & trapezius, sparing the soft palate.

Case reports

An Unusual Presentation of Tapia Syndrome Mimicking a Partial Wallenberg Syndrome Following Anterior Cervical Spine Surgery 3).


A 47-year-old man underwent posterior decompressive laminectomy for cervical stenosis. The surgery took about 117 minutes and it was uneventful. Postoperatively he developed hoarseness of voice during speech, with deviation of tongue protrusion. On laryngoscopic examination, paralysis of the left side of the tongue and the soft palate was found and complete palsy of the left vocal cord was noted. After excluding surgical cause and craniocervical lesion, a clinical diagnosis of Tapia syndrome was made. Here we report a rare case of Tapia syndrome developed after posterior approach for cervical spine surgery and discuss the possible mechanisms of this uncommon syndrome 4).


Two patients who underwent posterior cervical surgery complained hoarseness and tongue palsy postoperatively. There is no direct anatomical relation between the operation, the vagus nerves and the hypoglossal nerves, and there is no record of displacement or malposition of the endotracheal tube. After several months, all symptoms are resolved. To avoid this problem in posterior cervical spine surgery, we suggest paying special attention to the position of the endotracheal tube to avoid excessive neck flexion before and during the positioning of the patient 5).


A 42-yr-old man who complained of hoarseness, dysphagia, and right deviation of the tongue with an atrophic change for 2 mos after he underwent C3-4 discectomy and anterior fusion body. We found that he has a diagnosis of a variant of Tapia syndrome, although recurrent laryngeal nerve injury did not seem to be involved according to a videofluoroscopic swallowing study and electromyography. Our case report demonstrates that the combined diagnostic tools of videofluoroscopic swallowing study, electromyography, and laryngoscopy can be very useful in localizing and evaluating the level of lesions in patients with Tapia syndrome 6).

References

1)

Krasnianski M, Neudecker S, Schluter A, et al. Central Tapia’s syndrome (“matador’s disease”) caused by metastatic hemangiosarcoma. Neurology. 2003; 61:868–869
2)

Silva AH, Bishop M, Krovvidi H, Costello D, Dhir J. Tapia syndrome: an unusual complication following posterior cervical spine surgery. Br J Neurosurg. 2019 Apr;33(2):217-218. doi: 10.1080/02688697.2017.1318109. Epub 2017 Apr 19. PubMed PMID: 28421823.
3)

Kerolus MG, Turel MK, O’Toole JE. An Unusual Presentation of Tapia Syndrome Mimicking a Partial Wallenberg Syndrome Following Anterior Cervical Spine Surgery. J Neurosurg Anesthesiol. 2018 Oct;30(4):379-381. doi: 10.1097/ANA.0000000000000443. PubMed PMID: 28671880.
4)

Kang JH, Kim DM, Kim SW. Tapia syndrome after cervical spine surgery. Korean J Spine. 2013 Dec;10(4):249-51. doi: 10.14245/kjs.2013.10.4.249. Epub 2013 Dec 31. PubMed PMID: 24891858; PubMed Central PMCID: PMC4040639.
5)

Park CK, Lee DC, Park CJ, Hwang JH. Tapia’s Syndrome after Posterior Cervical Spine Surgery under General Anesthesia. J Korean Neurosurg Soc. 2013 Nov;54(5):423-5. doi: 10.3340/jkns.2013.54.5.423. Epub 2013 Nov 30. PubMed PMID: 24379951; PubMed Central PMCID: PMC3873357.
6)

Park J, Ahn R, Weon Y, Yang D. Diagnosing Tapia syndrome using a videofluoroscopic swallowing study and electromyography after anterior cervical spine surgery. Am J Phys Med Rehabil. 2011 Nov;90(11):948-53. doi: 10.1097/PHM.0b013e31823286e0. PubMed PMID: 21955952.

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