Abductor paralysis of both vocal cords is, fortunately, a very unusual occurrence. Like unilateral abductor palsy, it is practically always due to organic disease. Thomson states that it is due either to bilateral pressure on the recurrent nerves or to a bulbar lesion, usually syphilitic, involving the recurrent centers in the medulla, which are situated in the floor of the fourth ventricle. If the cardiac inhibitory center is also involved, as evidenced by a rapid pulse without fever, and if other nearby cerebral centers are affected, such as those of the eyes, tongue and pharynx, the localization points rather definitely toward the medulla. If, however, these signs are not present, one concludes that there is simultaneous peripheral involvement of the two recurrent laryngeal nerves. This rare condition is illustrated by the following case:
G. E., a woman aged 30, was brought into the hospital complaining of extreme difficulty in breathing