We prospectively determined the frequency of vocal cord paresis (VCP) among
first-ever acute ischemic stroke patients. Vocal cords were examined endos
copically within 48 h of stroke onset, at 1 week and 1 month. Of the 54 stu
dy patients, 64.8% had lacunar (group 1), 22.2% cortical/large subcortical
(group 2), 9.3% lateral medulla (group 3) and 3.7% other brainstem (group 4
) infarcts. VCP was found in 11 (20.4%): 11.4% of group 1, 16.4% of group 2
, 100% of group 3 and 0% of group 4. VCP was contralateral to the brain les
ion in groups 1 and 2, and ipsilateral in 80% of group 3. VCP was strongly
correlated with dysphonia (p < 0.0001) and resolved in 2/11 patients after
1 week and in 5/11 after 1 month. Our finding of VCP among acute ischemic s
troke patients questions the belief that the nucleus ambiguous is invariabl
y bilaterally innervated by supranuclear centers.