Lead breakage and vocal cord paralysis following blunt neck trauma in a patient with vagal nerve stimulator

Patients with medically intractable seizures who are not candidates for epilepsy surgery are left with few options. Vagal nerve stimulation therapy is often a viable alternative for these patients and can have a positive impact on quality of life. Rarely complications may occur. We report a case of mild blunt neck trauma resulting in VNS malfunction and delayed vocal cord paralysis. A systematic review of the literature on VNS malfunction, self-inflicted injuries, vagal nerve injury, and common side effects including voice changes was performed. Only a handful of relevant publications were found. Symptoms following VNS dysfunction include pain, dyspnea, and dysphonia. These symptoms are usually nonspecific, and in many cases, do not help differentiate from vagal nerve traction, lead breakage, or pulse generator malfunction. In our case, lead fracture and visible traction injury to the left vagus nerve were seen during surgical exploration. The vocal cord function completely recovered after revision of the leads. Prompt medical attention including appropriate diagnostic studies and early surgical exploration is necessary in cases of delayed vocal cord dysfunction and can help prevent long-term complications such as neuroma formation. The authors present a unique case of reversible vocal cord injury from blunt neck trauma leading to left vagus nerve damage.