Case report of dysphagia following resection of acoustic neuroma with postoperative hemorrhage of brain stem and cerebellum

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  • 聴神経腫瘍術後に脳幹・小脳出血を合併し摂食嚥下障害を認めた1症例

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Abstract

We report a case of a 56-years old woman with dysphagia following resection of acoustic neuroma. She underwent an operation for tumor in February, 2017. After the surgery, hemorrhage of left cerebella and a low density area in the pons and medulla were detected, which was surgically treated with evacuation of hematoma and decompressive craniectomy. First physical examination performed on the 11th day after the surgery revealed cerebellar and vestibular symptoms including posture holding difficulty and ataxic dysarthria and bulbar palsy including facial palsy, impairment of tongue and palatal movements. A score of repetitive saliva swallowing test was 2 and that of modified water swallowing test was 3a. Videoendoscopic examination revealed 1) pharyngeal residues and laryngeal penetration of secretion at rest, 2) fixation of left arytenoid cartilage and vocal cord with incomplete glottal closure, and 3) weak whiteout and regurgitation of bolus into the nasopharynx during swallowing as well as silent aspiration. Because the patient suffered from severe dysphagia, oral care and indirect therapy were started. On the 19th day, direct therapy was started because the durability was improved. Videofluoroscopic examination performed on the 35th day, revealed no improvement of function so that we continued indirect and direct therapies. Before hospital transfer, final examination was performed on the 55th day and no dynamic changes in the bulbar palsy were noted. However, the patient acquired safe methods to take some foods in the dysphagia rehabilitation including indirect and direct therapies and position adjustment.

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