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Case Report

Isolated palatal palsy: a clinical rarity

Harpreet Singh, Rekha Mathur, Parminder Kaur
Department of Medicine, Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India.

ABSTRA CT
Acquired isolated palatal palsy is a rare disease. It is commonly seen in children. It usually presents with acute onset nasal regurgitation
of fluids, rhinolalia, and palatal asymmetry. Many causes of this disease, such as infections, trauma, tumor, and brainstem lesions,
etc., have been reported. However, the most plausible explanation is immunological/ischemic damage to the affected nerve. After
ruling out major potential causes of this disease, the damage is often considered to be idiopathic in nature. This disease has a benign
self‑limiting course with excellent recovery. In accordance with a hypothesized immunological basis for this condition, treatment with
steroids results in significant improvement in its clinical features.

Key words: Idiopathic, palatal palsy, rhinolalia

INTRODUCTION phonation [Figure 1]. The vocal cords were normal on
both sides. All other vital parameters and examinations
Unilateral acquired isolated palatal (velopalatopharyngeal) were normal.
paralysis is a clinical rarity usually seen in children.
This isolated palatal palsy is the result of isolated Laboratory tests showed a hemoglobin concentration
involvement of the pharyngeal branch of the vagus of 15.2 g/dL, leukocyte count of 7000/mm , differential
3
nerve, which supplies motor fibers to muscles of the leukocyte count of 58/38/2/2, and absolute platelet
pharynx and soft palate. It was first described in 1976 by count of 2.5/mm . Blood and throat swab cultures were
3
Edin et al., however its precise etiopathogenesis is still sterile. Cerebrospinal fluid analysis showed a leukocyte
[1]
unclear. In the literature, infection-associated cranial count of 4/mm consisting entirely of lymphocytes,
3
mononeuropathy is frequently postulated as a possible sugar levels of 54 mg/dL, and protein levels of 29 mg/dL.
cause, although a definite link is still uncertain. A case Viral serology for human immunodeficiency virus,
report of acquired isolated palatal palsy in a young hepatitis B virus (HBV), herpes simplex virus (HSV),
adult is presented below, along with an overview of the and Japanese encephalitis virus was negative. Due to
available literature. resource constraints, however, other viral causes could
not be ruled out. Chest X-ray, electrocardiogram, and
CASE REPORT diffusion-weighted magnetic resonance imaging (MRI)
of the brain revealed no abnormalities [Figure 2].
We report a case of a 15-year-old, completely immunized,
previously healthy male, admitted with complaints of A short course of prednisolone at 0.5 mg/kg/day was
rhinolalia and nasal regurgitation of fluid for 2 days, prescribed for 5 days, followed by 0.25 mg/kg/day
which was sudden in onset, nonprogressive, and for another 5 days. On the 7th day after admission,
painless. The oral cavity showed no pseudomembrane. rhinolalia and nasal regurgitation of liquids subsided
The gag reflex was present bilaterally, but there was and the uvula was central upon phonation [Figure 3].
less movement of the palate on the right side, and The patient was re-evaluated every 2 weeks for the
the uvula was deviated toward the left side upon next 2 months. He remained asymptomatic during
follow-up visits.
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Quick Response Code: DISCUSSION
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www.nnjournal.net
Isolated acquired velopalatopharyngeal hemiparalysis
DOI: is rare, affecting primarily males (80%) in their first
10.4103/2347-8659.153981 or second decade of life. Generally, it presents with
[2]
rhinolalia and ipsilateral nasal escape of fluid with

Corresponding Author: Dr. Rekha Mathur, Department of Medicine, Post Graduate Institute of Medical Sciences, Medical Road,
Rohtak 124001, Haryana, India. E‑mail: drrekhamathur04@gmail.com

190 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 191