Isolated Bilateral Tapia’s syndrome after several oro-tracheal intubations: anatomical and pathophysiological considerations

Bilateral Tapia’s syndrome is an exceptionally rare neurologic complication which can follow invasive airway manipulations. Up to the present day, only seven cases have been reported in the literature (Bilbao et al. 2016; Coninckx et al. 2015; Sønnichsen and Lauritsen, 2013; Turan et al., 2012; Cinar et al., 2005, McCleary et al., 1993, Takimoto et al., 1991). Stretching and compression of both hypoglossal (XII) and recurrent laryngeal (X) nerves are the main mechanisms responsible for inducing this uncommon syndrome during challenging oro-tracheal intubations. Intensive care physicians and neurologists should be aware of its causes, consider its occurrence in case of repetitive intubation maneuvers and promptly recognize its pathognomonic clinical features in order to start an intensive and multidisciplinary swallowing and speech rehabilitation. Needle electromyography (EMG) is a valuable tool to corroborate the diagnosis and to predict the patient recovery