Abstract
A 57-year-old male patient was emergently transferred to our institution after he lost consciousness in his vehicle. Careful neurological examinations led to the diagnosis of frontal lobe glioma. Chemoradiotherapy was administered with temozolomide and fractionated radiotherapy at 60 Gy. While his consciousness level gradually improved during the treatment, dysphagia and dysarthria became apparent. The patient was referred to our department for evaluation of the dysphagia. According to the first impression, he could not swallow, but nevertheless seemed desirous of oral intake. Video-assisted endoscopic and fluorographic examination revealed that he had no sensory or motor impairment of the lips, soft palate, tongue, pharynx or larynx. The pharyngeal phase of swallowing was considered normal, however, failure of the oral phase of swallowing was occasionally observed. Although he was able to swallow saliva unconsciously, he could not transport a bolus into the pharynx from the oral cavity if he felt something in his mouth. We made a final diagnosis, based on the clinical findings, of oral-phase swallowing apraxia complicating frontal lobe glioma. The site of involvement in this disorder was thought to be the neurotransmission pathway to the thalamus from the primary motor cortex in the cerebrum. In an attempt to restore the sensation for oral ingestion, the patient received rehabilitation with ingestion-mimicking therapy.
