Simple Dysphagia Due to Lateral Medullary Infarction: A Case Report

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  • Saito Daisuke
    Department of Otolaryngology, National Sendai Medical Center Department of Otolaryngology-Head and Neck Surgery, Iwate Medical University
  • Watanabe Ken-ichi
    Department of Otolaryngology-Head and Neck Surgery, Tohoku University
  • Amano Masaki
    Department of Otolaryngology, National Sendai Medical Center
  • Nakanome Ayako
    Department of Otolaryngology-Head and Neck Surgery, Tohoku University
  • Oikawa Shin-ichi
    Department of Otolaryngology-Head and Neck Surgery, Iwate Medical University
  • Hashimoto Sho
    Department of Otolaryngology, National Sendai Medical Center

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Other Title
  • 嚥下障害のみを呈した延髄外側梗塞の1例
  • 症例 嚥下障害のみを呈した延髄外側梗塞の1例
  • ショウレイ エンカ ショウガイ ノミ オ テイシタ エンズイ ソトガワ コウソク ノ 1レイ

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<p>Lateral medullary infarction, also known as Wallenberg syndrome, usually causes multiple neurologic symptoms such as contralateral deficit in pain and temperature sensation, disequilibrium, dysphagia and Horner syndrome, but onset with a single symptom is rare. Here we present a case of simple dysphagia due to right lateral medullary infarction.</p><p>An otherwise healthy 66-year-old male presented with a four-day history of dysphasia without any other neurological findings. Videofluoroscopic swallowing study showed dysphasia and aspiration, but the patient had no recurrent nerve paralysis. Enhanced CT scan (head to chest) demonstrated no particular lesion. On the third day of admission, brain MRI including DWI (diffusion-weighted imaging) was performed and a small lesion from right lateral medullary infarction was revealed.</p><p>Swallowing is regulated by the nucleus tractus solitarii, dorsal motor nucleus of the vagus, central pattern generator (CPG) and nucleus ambiguus, and among these CPG plays a key role. In the present case, the lesion of infarction appeared to involve only a small area including the CPG and nucleus ambiguus. This finding seemed to explain the reason why the patient showed simple dysphagia without other symptoms.</p>

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