Intra cranial space occupying lesion have been known to present  with varied symptoms and signs, mostly related to CNS since the involvement of brain parenchyma directly or the pressure effects of the intracranial space occupying lesion lead to varied manifestations ranging in severity from a mild headache to coma and varied neurological deficits. We take the opportunity to present a case report of this 63 year old male patient who was admitted with a primary diagnosis of pneumonia with ARDS, further investigation revealed a unilateral vocal cord paralysis secondary to anintra cranial space occupying lesion, although the patient was asymptomatic for any neurological symptoms previously and the prime presentation was with cough and fever of five days duration. The unusual thing about this case was the masking effects of ARDS and shock which lead to ambiguity of diagnosis in view of no underlying medical ailment. 

 

Keyword: Vocal Cord Paralysis;  Intracranial Space Occupying Lesion;  Aspiration Pneumonia.