A Case of Dysphagia Subsequent to Bilateral Medial Medullary Infarction

Abstract

We report the case of a 42-year-old man with severe dysphagia and quadriplegia subsequent to bilateral medial medullary infarction. On the 16th day after the stroke onset, a tracheostomy was performed due to pneumonia and tube feeding was implemented. An endoscopic swallowing examination showed a poor reflexive swallow followed by silent aspiration of saliva pooled in the pyriform sinuses.

After 3 months of rehabilitation, the tracheostomy tube was removed and oral feeding of a modified diet was initiated. The videofluoroscopic examination revealed incomplete pharyngeal contraction but normal opening of cricopharyngeal sphincter. The Mendelson maneuver and supraglottic swallow were applied to improve the laryngeal elevation and avoid laryngeal penetration, respectively. Six months after the onset, the patient eventually could eat normal meals.

Severe dysphagia due to bilateral medial medullary infarction is known to demonstrate poor prognosis. Our case, however, suggests the possibility of recovering from dysphagia in young patients who are free of respiratory disorders and who make rehabilitation efforts for tracheostomy weaning and oral feeding.