Acute dysphagia: A rare initial symptom of lateral medullary syndrome: A case report. (December 2022)

• Record Type: Journal Article
• Authors: Ali, Farhan; Zubair, Amraha; Nazir, Fatima; Ali, Kashif; Mansoor, Sobia
• Is Part Of: Annals of medicine and surgery. Volume 84(2022)
• Publication Date: 2022-12
• Subjects: Wallenberg syndrome -- Posterior inferior cerebellar artery -- Stroke -- Trauma -- Dysphagia -- Case report; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2022.104851
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction and importance: A unique etiology of stroke, lateral medullary syndrome (LMS), is a consequence of posterior inferior cerebellar artery or vertebral artery thromboembolic conditions. LMS patients present particularly with ipsilateral hyperalgesia, ipsilateral ataxia, and Horner's syndrome. Our case signifies that neurogenic origin should always be considered in the absence of local causes of dysphagia. Early diagnosis could prevent LMS complications, including neurological disabilities. A scarcity of research related to dysphagia in LMS, and its outcomes exists. Therefore, the objective is to investigate the clinical course in a patient afflicted with severe dysphagia following a diagnosis of (LMS). This would encourage further research, thus improving management and treatment strategies. Case presentation: We report a case of a 45-year-old male, a smoker for 20 years, who presented with a single, unique complaint of acute dysphagia for 9 days. According to our knowledge, this is among very few reported cases of LMS with dysphagia being the rare initial complaint. The neurological issues associated with dysphagia gradually improved with the administration of antiplatelet; clopidogrel and lipid-lowering drug; rosuvastatin and the patient was discharged. Atypical presentation in LMS could be supported by the presence of lateral medullary infarct which was confirmed by MRI (Magnetic Resonance Imaging). Clinical discussion: Dysphagia is a common complaint in multiple gastrointestinal (GI) settings. However, in cases where the GI causes are excluded, as described here, diagnosis of LMS becomes tough. Conclusion: The diagnosis of LMS was queried owing to the presentation of the single most important common symptom, with no other characteristic manifestations of LMS. Highlights: Lateral Medullary Syndrome (LMS) is caused by thromboembolic occlusive conditions. LMS affects the swallowing centers in the dorsolateral medulla, like nucleus ambiguous and reticular formation. Dysphagia, the triad of Horner's syndrome, vertigo, and hypoalgesia are among the classical LMS features. Single and early presentation of acute dysphagia is a rare presentation of LMS. An acute infarct in the left lateral medulla on MRI confirmed the diagnosis of LMS.