2016 年 30 巻 2 号 p. 193-197
Ankylosing spinal hyperostosis (ASH) is characterized by the presence of anterior cervical osteophytes. Although osteophytes in ASH are generally asymptomatic, large osteophytes sometimes can cause dysphagia. We report a case of ASH with dysphagia that rapidly became exacerbated after a seizure.
A 65-year-old man was brought to the emergency department with traumatic brain injury. After conservative treatment, he was discharged home. Six months later, he was again brought to the emergency department with a convulsive seizure. He was diagnosed with symptomatic epilepsy and was hospitalized. After admission, he was seizure-free. Although he regained consciousness after admission, he experienced severe dysphagia and developed aspiration pneumonia. Computed tomography demonstrated anterior cervical osteophytes from the C2 to the C7 levels. Further examination did not reveal any other coexisting diseases that could affect the swallowing function. These osteophytes were diagnosed as the cause of dysphagia and he underwent rehabilitation. However, his swallowing function did not improve and surgical resection of the osteophytes was performed. After the procedure, his swallowing function improved and he was transferred to another hospital for rehabilitation.
Dysphagia caused by ASH progresses slowly in most cases. In this case, dysphagia rapidly became exacerbated after a seizure. Subclinical dysphagia caused by ASH had led to chronic undernourishment. Following the seizure, the patient was bedridden for several days. This caused severe muscle atrophy and resulted in rapid exacerbation of dysphagia.
This is the first report of ASH with dysphagia that rapidly became exacerbated after a seizure. It is important to recognize that subclinical dysphagia caused by ASH can become worse after a short period of being bedridden, as it is often associated with chronic undernourishment.
