Three months after onset, percutaneous endoscopic gastrostomy (PEG) was performed, and tubal feeding was continued. 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. We also discuss the mechanism of our successful pharmacological approach to treat dysphagia combined with dystonia.Ī 43-year-old woman was admitted to the rehabilitation clinic due to severe drooling and dysphagia. Herein, we report a rare case of improvement with pharmacotherapy in dysphagia caused by focal pharyngeal dystonia in a 43-year-old woman. Some studies have reported dysphonia and dysphagia due to pharyngeal dystonia, but a treatment strategy has not yet been established. However, dystonia localized only in the pharyngeal muscle is extremely rare, and its pathogenesis is unclear and scarcely reported. Meanwhile, little is known about pharmacotherapy.Īpart from CPD, inappropriate relaxation of the pharyngeal muscle, called pharyngeal dystonia, also occurs and is often reported in cases of lesions in the cerebellum rather than the basal ganglia. ![]() To date, CPD treatment is focused on the relaxation of the cricopharyngeus muscle, for which methods such as injection of botulinum neurotoxin (BoNT), balloon dilatation, and myotomy are often used. Ĭricopharyngeal dysphagia (CPD) is a swallowing disorder caused by an inappropriate constriction of the cricopharyngeal muscle, and the medulla is the most causative location. As various parts of the brain are involved in swallowing, clinical manifestations of swallowing disorder vary. Dysphagia after stroke is a common symptom reported in 28%–65% of patients.
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