General Management Goals

During the initial evaluation of a patient with disorders attributable to the ninth and tenth cranial nerves, few specific precautions for management are indicated. Bilateral vagus nerve lesions, regardless of the pathological process, occlude the airway by opposition of the vocal cords in the midline. This condition is an emergency and requires endotracheal intubation to maintain airway patency. Patients with bradycardia or asystole due to increased vagal output are treated initially with atropine or cardiac pacing until the causative process is addressed. It should be kept in mind that the condition of patients with lateral medullary syndrome by infarction may be unstable. Status may decline clinically by pressure effects in the posterior fossa or by extension of the area of infarction by propagation of clot or embolization from the vertebral artery into the basilar artery. It is not clear that the risks of intravenous heparin are justified to attempt to prevent stroke extension.


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