11/23/2023 0 Comments Inferior pharyngeal constrictorVFSS is the gold standard for swallowing process evaluation, which visually confirms the flow of food. The pathogenesis of focal pharyngeal dystonia after brain injury is unclear. We present a rare case of a patient with dysphagia due to focal dystonia in the pharynx, which showed dramatic improvement with pharmacotherapy, despite the lack of symptom improvement for over 1 year from disease onset. Patient was taking aspirin and clopidogrel for the history of coil embolization and cerebellar infarction, and lansoprazole for the symptom of reflux. However, issues in oromotor function were not suspected because pronunciation and articulation were clear without deviation of the tongue and uvula. Sensation and gag reflex were diminished, and hoarseness due to left vocal cord palsy was observed. Pathological reflex was not elicited, and ataxia was not notable. The left upper and lower limbs showed slightly hyperactive deep tendon reflex compared to the right side. However, a definite focal motor deficit was not observed on both the upper and lower extremities. Later, she was confirmed to have lesions of the pons, medulla, and cerebellum due to left posterior inferior cerebellar artery infarction detected by magnetic resonance imaging of the brain. One year and 2 months ago, she underwent coil embolization for subarachnoid hemorrhage due to left vertebral artery aneurysm rupture. Keywords: Deglutition disorders, Dystonia, Drug therapyĪ 43-year-old woman was admitted to the rehabilitation clinic due to severe drooling and dysphagia. Therefore, we suggest that physicians should make a differential diagnosis of combined dystonia in patients complaining of dysphagia by esophageal manometry and electromyography. Moreover, she could consume food orally however, this was limited to small amounts of liquid, and the main method of nutrition support was via an orogastric tube. After adjusting the drug dose, the patient was able to perform social activities without drooling. Medications for dystonia dramatically helped with saliva control and resulted in a small improvement in the progression of food from the pharyngeal to esophageal phase. Despite the injection of botulinum neurotoxin, no symptom improvement was achieved and pharyngeal dystonia was considered as the cause. Videofluoroscopic swallowing study showed compatible findings of cricopharyngeal dysphagia. A 43-year-old woman suffered from drooling and dysphagia after a stroke in the left posterior inferior cerebellar artery territory.
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