Supplementary Material for: Tapia's Syndrome Following Non-Invasive Continuous Positive Airway Pressure (CPAP) Therapy: A Case Report

Background: Tapia's syndrome is a rare neurological condition defined by concurrent unilateral paralysis of the vagus (cranial nerve X) and hypoglossal (cranial nerve XII) nerves.1 It is most commonly reported as an iatrogenic complication of procedures involving airway manipulation, such as orotracheal intubation.2 This report describes a unique case of Tapia's syndrome with a temporal association to the initiation of non-invasive Continuous Positive Airway Pressure (CPAP) therapy.

Case Presentation: A 66-year-old female presented with a four-day history of acute-onset dysphonia, dysphagia, and right-sided tongue deviation. Her symptoms began shortly after initiating CPAP therapy with a full-face mask for newly diagnosed obstructive sleep apnea. She had also recently received multiple vaccinations. Clinical examination revealed right-sided vagus and hypoglossal nerve palsies, and laryngoscopy confirmed right vocal cord paralysis. Extensive diagnostic evaluation, including magnetic resonance imaging (MRI) and angiography (MRA) of the brain and neck, effectively excluded central nervous system pathologies such as stroke, demyelinating disease, or mass lesions. The patient was managed by discontinuing CPAP and administering a course of oral corticosteroids, alongside speech and swallowing therapy. She experienced a near-complete resolution of her symptoms over six weeks.

Conclusion: This case suggests that Tapia's syndrome can be a rare complication of non-invasive airway support. A multifactorial etiology involving mechanical nerve compression from the CPAP apparatus, potentially compounded by an immune-mediated nerve sensitization from recent vaccinations, should be considered in the differential diagnosis of lower cranial neuropathies.