2025 Volume 37 Issue 2 Pages 43-48
Acute dysphagia is associated with poor long-term prognosis and increased mortality in patients with lateral medullary infarction. A 58-year-old man who presented with sudden-onset right facial pain, dysarthria, dysphagia, and lateropulsion was diagnosed as right lateral medullary syndrome. Neurological examination revealed loss of pain and thermal sensation in the right face and left limbs. Initial brain magnetic resonance imaging (MRI) showed no abnormalities; however, repeated diffusion weighted MRI identified a high intensity signal in the right lateral medulla. Swallowing assessments revealed impaired right pharyngeal and laryngeal movement with inadequate relaxation of right upper esophageal sphincter (UES). Esophageal manometry showed decreased pharyngeal pressure and increased UES pressure. Based on these findings, the patient was diagnosed with type 1 dysphasia associated with lateral medullary syndrome, and treatment was initiated, including cervical rotation to the affected side, food modification and balloon dilation therapy. Despite being unable to swallow saliva at admission, the patient regained this ability by day 25. By day 48, UES function improved, allowing discontinuation of balloon dilation therapy. The patient resumed normal oral intake by day 54 and was discharged home. This case highlights the importance of early balloon dilation therapy, guided by precise swallowing evaluations, in rapidly improving severe dysphagia.
