A patient with a left medullary infarction in whom the bolus passage side of the cricopharyngeal region changed from the affected to the bilateral sides

Abstract

This report describes a rare case of a patient with a left medullary infarction in whom the bolus passage side of the cricopharyngeal region changed from the affected to the bilateral sides. The patient was a 57-year-old male admitted for a left lateral medullary infarction associated with a dissecting aneurysm of the vertebral artery. A videofluoroscopic examination of swallowing (VF) performed on the 31 st day the hospital demonstrated that the bolus passed only though the affected left side of the cricopharyngeal region and did not pass though the healthy side. The bolus normally tends to be transferred from the oral cavity to the affected side of pharynx. Intermittent oro-esophageal tube feeding, balloon dilatation of the cricopharyngeal region and stepwise food ingestion therapy using jerry diets with the right rotation of the neck in the left lateral position were therefore initiated. VF on the 87 th hospital day detected bolus passage on the healthy right side of the cricopharyngeal region, thus showing an alteration in the passage on the bilateral sides.