Brainstem infarct with pharyngeal dysmotility and paralyzed vocal cord : management with a multidisciplinary approach

An unusual case of right posterior brainstem infarction with isolated deficits of severe dysphagia and ataxia is presented. Neurological examination revealed dysfunction of the pharyngeal and laryngeal branches of cranial nerves IX, X, and a paralyzed right vocal cord. The patient was unable to swallow 1/4 teaspoon of applesauce. Modified barium swallow revealed extremely sluggish pharyngeal peristalsis and absent swallowing reflex. Percutaneous esophageal gastrostomy tube was inserted and an intensive dysphagia rehabilitation program was initiated. Pharyngeal-phase-oriented protocol was used. Results were significantly improved compensatory pharyngeal and laryngeal function with restoration of swallowing and no aspiration. This case illustrates successful management of dysphagia associated with brainstem infarction and the benefits of a coordinated multidisciplinary protocol.