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khan U, Ahmad B, Aslam A, Muhammad A, Iqbal J. Opalski syndrome, a rare variant of wallenberg syndrome, the first case reported from Pakistan: A case report. Heliyon 2023; 9:e21687. [PMID: 38027725 PMCID: PMC10665721 DOI: 10.1016/j.heliyon.2023.e21687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Wallenberg syndrome, also known as a lateral medullary syndrome, is a rare neurological condition caused by an infarction in the brainstem's lateral medulla. There are subtypes of Wallenberg syndrome with distinctive and atypical symptoms, such as Opalski syndrome. Case presentation A 41-year-old hypertensive male arrived at the emergency department with abrupt onset of right-sided bodily weakness, vertigo, facial numbness, dysphagia, hoarseness of voice, and double vision. The neurological examination indicated right hemiparesis, right facial numbness, crossed sensory deficit, right limb ataxia, right uvulopalatal deviation, and vertical double vision. An MRI showed a lateral medullary infarct leading to the suspicion of the atypical lateral medullary syndrome. The patient was treated with physiotherapy and daily oral medications including aspirin, clopidogrel, atorvastatin, and Cap Risek. On follow-up 14 days later, the patient's condition had significantly improved. Conclusion This case study demonstrates the significance of recognizing atypical variants of Wallenberg syndrome, such as Opalski syndrome, in order to provide a correct diagnosis and the most effective treatment. Our patient's condition improved as a result of the therapy measures used, however, people with Opalski syndrome may have a poor prognosis and require continuous monitoring.
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Affiliation(s)
- Ubaid khan
- King Edward Medical University, Lahore, Pakistan
| | - Bilal Ahmad
- King Edward Medical University, Lahore, Pakistan
| | - Ayesha Aslam
- King Edward Medical University, Lahore, Pakistan
- Mayo Hospital, Lahore, Pakistan
| | | | - Javed Iqbal
- King Edward Medical University, Lahore, Pakistan
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Herson AB, Falk JD, Phrathep DD, Igbonagwam CB, Fischer ST, Miller BT, Leary D. The Value of Interdisciplinary Collaboration in Lateral Medullary Syndrome Rehabilitation: A Case Report. Cureus 2023; 15:e40065. [PMID: 37425557 PMCID: PMC10326168 DOI: 10.7759/cureus.40065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Wallenberg's syndrome, also known as lateral medullary syndrome (LMS), is a neurological condition resulting from damage to the lateral portion of the medulla oblongata. We present a case of a 64-year-old man with Wallenberg's syndrome who presented for acute rehabilitation after sustaining a cerebrovascular accident (CVA). As seen in our patient, common symptoms of LMS include difficulty swallowing, hoarseness, ipsilateral weakness, and ipsilateral loss of sensation or numbness. Although the prognosis following infarction is often good, dysfunction in swallowing is one of the key deficits that have a long-term impact on patient quality of life. We aim to emphasize the significance of the interdisciplinary approach to achieving favorable health outcomes in patients with LMS.
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Affiliation(s)
- Andrew B Herson
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Justin D Falk
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Davong D Phrathep
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Chigozie B Igbonagwam
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Steven T Fischer
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Brooke T Miller
- Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Daniel Leary
- Physical Medicine and Rehabilitation, AdventHealth Tampa, Tampa, USA
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Roy P, Akpoigbe O, Akanmode AM, Anim-Koranteng C, Olusoji R. Food Stuck in the Throat in a Newly Diagnosed Diabetes Mellitus Patient: An Atypical Presentation of Wallenberg's Syndrome. Cureus 2023; 15:e38076. [PMID: 37234141 PMCID: PMC10208627 DOI: 10.7759/cureus.38076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Wallenberg's syndrome, also known as posterior inferior cerebellar artery syndrome (lateral medullary syndrome), is known to be a common cause of posterior ischemic stroke syndromes in men in their 60s and may present with varied symptoms devoid of focal neurological signs making it easily missed as a differential of posterior ischemic strokes. It involves a stroke in the vertebral or posterior inferior cerebellar artery of the brainstem. In this case report, we critically examine the case of a 66-year-old man with newly diagnosed diabetes whose main presentation was dysphagia and unsteady gait. There was no motor or sensory examination finding in our patient, and the initial computed tomography of the brain was negative for any intracranial pathology leading to very low suspicion of stroke. However, given a high index of suspicion and a thorough oropharyngeal examination ruling out structural abnormality, magnetic resonance imaging of the brain revealed features suggestive of Wallenberg's syndrome. This case emphasizes careful consideration of posterior stroke syndrome when evaluating patients presenting with dysphagia without typical motor/sensory symptoms of cerebrovascular accident and the requirement of further imaging to support the diagnosis.
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Affiliation(s)
- Pooja Roy
- Internal Medicine, Harlem Hospital Center, New York, USA
| | | | | | | | - Rahman Olusoji
- Internal Medicine, Harlem Hospital Center, New York, USA
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Alloush TK, Alloush AT, Sami M, Shokri HM. Sinus arrest following acute lateral medullary infarction. Neurol Sci 2022; 43:6555-6559. [PMID: 35925455 PMCID: PMC9616784 DOI: 10.1007/s10072-022-06306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/24/2022] [Indexed: 11/15/2022]
Abstract
Lateral medullary syndrome (LMS) is an ischemic stroke of the medulla oblongata that involves the territory of the posterior inferior cerebellar artery. LMS is often missed as the cause of autonomic dysregulation in patients with recent brain stem stroke. Due to the location of the nucleus tractus solitarius (NTS), the dorsal vagal nucleus, and the nucleus ambiguous in the lateral medulla oblongata, patients with LMS occasionally have autonomic dysregulation–associated clinical manifestations. We report a case of LMS-associated autonomic dysregulation. The case presented by recurrent syncope, requiring permanent pacemaker placement. This case shows the importance of recognizing LMS as a potential cause of life-threatening arrhythmias, heart block, and symptomatic bradycardia. Extended cardiac monitoring should be considered for patients with medullary strokes.
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Kunieda K, Sugiyama J, Nomoto A, Ohno T, Shigematsu T, Fujishima I. Compensatory swallowing methods in a patient with dysphagia due to lateral medullary syndrome-vacuum and prolonged swallowing: A case report. Medicine (Baltimore) 2022; 101:e28524. [PMID: 35029918 PMCID: PMC8735762 DOI: 10.1097/md.0000000000028524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The nature of pharyngeal swallowing function during the course of recovery of dysphagia due to lateral medullary syndrome (LMS) is unclear. Vacuum swallowing is a compensatory swallowing method that improves the pharyngeal passage of a bolus by creating negative pressure during swallowing in the esophagus in patients with dysphagia due to LMS. We present a case involving a patient with dysphagia due to LMS who involuntarily acquired a swallowing method with prolonged and increased pharyngeal contraction and vacuum swallowing. PATIENT CONCERNS We report a unique case involving a 52-year-old patient with dysphagia due to LMS. His dysphagia was severe but improved gradually with swallowing rehabilitation. The patient involuntarily acquired a swallowing method with prolonged and increased pharyngeal contraction and vacuum swallowing. DIAGNOSIS The patient presented with dysphagia due to left LMS. A videofluoroscopic examination of swallowing revealed pharyngeal residue. INTERVENTIONS Forty-five days after the onset of the dysphagia, the swallowing pressure along the pharynx and esophagus was measured using high-resolution manometry. OUTCOMES Vacuum swallowing was observed in six out of 19 swallows (32.5%). The velopharyngeal contractile integral (CI) and mesohypopharyngeal CI values increased during swallowing, reflecting prolonged and increased pharyngeal contraction. We named this swallowing method "prolonged swallowing." CONCLUSION The findings in this case indicate that vacuum and prolonged swallowing may be compensatory swallowing methods observed in individuals recovering from dysphagia due to LMS. Further research is needed to clarify the relationship between these swallowing methods and the pathophysiology, prognosis, and treatment of dysphagia in patients with LMS.
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Affiliation(s)
- Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Junya Sugiyama
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
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Li B, Zhang T, Zhao J, Li P, Wu Z, Zhao S. Can non-swallowing function assessment predict nasogastric tube removal in patients with poststroke dysphagia? A clinical study. Front Neurol 2022; 13:984707. [PMID: 36938369 PMCID: PMC10014454 DOI: 10.3389/fneur.2022.984707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/03/2022] [Indexed: 03/04/2023] Open
Abstract
Objective This study aimed to predict nasogastric tube (NGT) removal in patients with poststroke dysphagia (PSD) by non-swallowing function assessment. Methods We enrolled 232 eligible patients and performed rehabilitation. The Fugl-Meyer assessment motor (FMM) and National Institute of Health Stroke Scale (NIHSS) scores were used to measure the motor and overall nervous system functions. Predictors for NGT removal in patients with PSD after rehabilitation were analyzed. Results Of the 232 included patients, the NGTs were removed from 78% of them, while 22% were dependent on a feeding tube after 4 weeks of rehabilitation. Compared to the preserved NGT group, older age, a higher rate of intubation or tracheostomy, and more severe baseline functions were found in the NGT removal group. Age [odds ratio (OR) = 0.907; 95% confidence interval (CI): 0.859-0.957; p = 0.000], difference in the FMM score after 4 weeks of rehabilitation (OR = 1.219; 95% CI: 1.145-1.299; p = 0.00), and item 9 of NIHSS (OR = 0.488; 95% CI: 0.252-0.946; p = 0.034) were predictors of NGT removal after rehabilitation. Conclusion We established a predictive model in patients with PSD using a non-swallowing assessment, which enabled us to predict swallowing recovery based on the non-swallowing function.
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Pellegrini JR, Munshi R, Cao B, Olson S, Cappello V. Hitting a Wall: An Ambiguous Case of Wallenberg Syndrome. Cureus 2021; 13:e16268. [PMID: 34373821 PMCID: PMC8346262 DOI: 10.7759/cureus.16268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/26/2022] Open
Abstract
Wallenberg syndrome is the most common stroke of the posterior circulation. Diagnosis of Wallenberg syndrome is often overlooked as initial MRI may show no visible lesion. We present an atypical case of Wallenberg syndrome in which the initial MRI of the brain was normal. Our patient is a 65-year-old male who was brought in by emergency medical services complaining of right-sided facial droop, slurred speech, and left-sided weakness for one day. Physical examination showed decreased left arm and leg strength compared to the right side, decreased left facial temperature sensations, decreased left arm and leg temperature sensations, and difficulty sitting upright with an associated leaning towards the left side. An initial magnetic resonance imaging (MRI) of the brain with and without contrast revealed no abnormality. In light of such a high suspicion for stroke based on the patient’s neurologic deficits, a repeat MRI of the brain was performed three days later and exposed a small focus of bright signal (hyperintensity) on T2-weighted fluid-attenuated inversion recovery and diffusion-weighted imaging (DWI) in the left posterior medulla. Wallenberg syndrome, also known as lateral medullary syndrome or posterior inferior cerebellar artery syndrome, is a constellation of symptoms caused by posterior vascular accidents. The neurological deficits associated with this disease are due to damage of the lateral medulla, inferior cerebellar peduncle, nucleus of trigeminal nerve, nucleus and fibers of vagus and glossopharyngeal nerves, descending sympathetic tract, spinothalamic tract, and/or vestibular nuclei. MRI with DWI is the gold standard to confirm the diagnosis. Wallenberg syndrome has the potential to leave patients extremely debilitated. Early detection, management, and rehabilitation are critical for improving post-stroke recovery.
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Affiliation(s)
| | - Rezwan Munshi
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Bohao Cao
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
| | - Samuel Olson
- Physical Medicine and Rehabilitation, Stony Brook University, Stony Brook, USA
| | - Vincent Cappello
- Internal Medicine, Nassau University Medical Center, East Meadow, USA
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8
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Miao HL, Zhang DY, Wang T, Jiao XT, Jiao LQ. Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature. Int J Med Sci 2020; 17:3005-3019. [PMID: 33173421 DOI: 10.7150/ijms.49137if:3.642q3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/07/2020] [Indexed: 05/27/2023] Open
Abstract
The posterior inferior cerebellar artery (PICA), with its unique anatomical complexity, is of great clinical importance and involved in many diseases including aneurysm, ischemic stroke, neurovascular compression syndrome (NVCS), arteriovenous malformation (AVM), and brain tumor. However, a comprehensive systematic review of the importance of the PICA is currently lacking. In this study, we perform a literature review of PICA by searching all the associated papers in the PUBMED database hoping to provide a better understanding of the artery. The PICA has tortuous and variable course and territory, divided into 5 segments. Various aneurysms involving PICA were not uncommon, of which the treatment is challenging. The PICA infarct typically manifests lateral medullary syndrome (LMS) and is more likely to cause mass effects. The PICA frequently compresses the medulla and the cranial nerves resulting in various neurovascular compression syndromes (NVCS). Arteriovenous malformation (AVM) fed by PICA are associated with aneurysm and dissection which have high risk of rupture and worse outcome. PICA injured by head trauma can cause fatal SAH. VA terminating in PICA probably cause Bow hunter's syndrome (BHS). The PICA supplies many brain tumors and can be used in intracerebellar chemotherapy. The PICA can be exposed and injured during surgeries especially in telovelar approach, and it also plays an important role in bypass surgeries, hinting the surgical importance of PICA. In conclusion, PICA is very important in clinical practice.
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Affiliation(s)
- Hui-Lei Miao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Deng-Yan Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
- School of General Practice and Continuing Education, Capital Medical University, Beijing 100069,China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
| | - Xiao-Tian Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
| | - Li-Qun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
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Dysphagia prognosis prediction via corticobulbar tract assessment in lateral medullary infarction: a diffusion tensor tractography study. Dysphagia 2020; 36:680-688. [PMID: 32865624 DOI: 10.1007/s00455-020-10182-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022]
Abstract
We investigated the capacity for dysphagia prognosis prediction using diffusion tensor tractography (DTT) to assess the state of the corticobulbar tract (CBT) during the initial period following lateral medullary infarction (LMI). Twenty patients with LMI and 20 control subjects were recruited for this study. The patients were classified into two subgroups: subgroup A (16 patients with nasogastric tube required for six months or less after LMI onset) and subgroup B (4 patients with nasogastric tube required for more than six months after onset). DTT was used to reconstruct the CBTs of each patient and control subject, and the fractional anisotropy (FA) and tract volume (TV) measurements were obtained. In the affected hemisphere, the FA value of the CBT was significantly lower in subgroup B than in subgroup A and the control group (p < 0.05), with no significant difference between subgroup A and the control group. In the affected and unaffected hemispheres, the TV values of CBT in subgroups A and B were lower than those of the control group (p < 0.05), with no significant difference between subgroups A and B. In addition, among the four patients of subgroup B, reconstruction of the CBT was not possible in three patients, and the remaining patients exhibited on old lesion in the corona radiate involving descending pathway of the CBT in the affected hemisphere. We found that the injury severity of the CBT in the affected hemisphere appeared to be related to a poor dysphagia prognosis following LMI. Our results suggest that evaluation of the CBT state during the early post-LMI could be useful for dysphagia prognosis prediction.
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Randev S, Goldstein L, Morgenstern K, Lekshminarayanan A, Altschuler EL. Clinical Conundrum: Severe Oropharyngeal Dysphagia. Dysphagia 2020; 35:733-734. [PMID: 32130513 DOI: 10.1007/s00455-020-10101-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Sonika Randev
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, 1901 First Avenue, New York, NY, 10029, USA
| | - Lara Goldstein
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, 1901 First Avenue, New York, NY, 10029, USA
| | - Kara Morgenstern
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, 1901 First Avenue, New York, NY, 10029, USA
| | - Anusha Lekshminarayanan
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, 1901 First Avenue, New York, NY, 10029, USA
| | - Eric L Altschuler
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, 1901 First Avenue, New York, NY, 10029, USA.
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11
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Miao HL, Zhang DY, Wang T, Jiao XT, Jiao LQ. Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature. Int J Med Sci 2020; 17:3005-3019. [PMID: 33173421 PMCID: PMC7646108 DOI: 10.7150/ijms.49137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022] Open
Abstract
The posterior inferior cerebellar artery (PICA), with its unique anatomical complexity, is of great clinical importance and involved in many diseases including aneurysm, ischemic stroke, neurovascular compression syndrome (NVCS), arteriovenous malformation (AVM), and brain tumor. However, a comprehensive systematic review of the importance of the PICA is currently lacking. In this study, we perform a literature review of PICA by searching all the associated papers in the PUBMED database hoping to provide a better understanding of the artery. The PICA has tortuous and variable course and territory, divided into 5 segments. Various aneurysms involving PICA were not uncommon, of which the treatment is challenging. The PICA infarct typically manifests lateral medullary syndrome (LMS) and is more likely to cause mass effects. The PICA frequently compresses the medulla and the cranial nerves resulting in various neurovascular compression syndromes (NVCS). Arteriovenous malformation (AVM) fed by PICA are associated with aneurysm and dissection which have high risk of rupture and worse outcome. PICA injured by head trauma can cause fatal SAH. VA terminating in PICA probably cause Bow hunter's syndrome (BHS). The PICA supplies many brain tumors and can be used in intracerebellar chemotherapy. The PICA can be exposed and injured during surgeries especially in telovelar approach, and it also plays an important role in bypass surgeries, hinting the surgical importance of PICA. In conclusion, PICA is very important in clinical practice.
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Affiliation(s)
- Hui-Lei Miao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China.,Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Deng-Yan Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China.,School of General Practice and Continuing Education, Capital Medical University, Beijing 100069,China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
| | - Xiao-Tian Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
| | - Li-Qun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Beijing 100032, China
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Yuan Y, Wang J, Wu D, Zhang D, Song W. Effect of Transcutaneous Vagus Nerve Stimulation in Dysphagia After Lateral Medullary Infarction: A Case Report. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1381-1387. [PMID: 31498703 DOI: 10.1044/2019_ajslp-18-0262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Severe dysphagia with weak pharyngeal peristalsis after dorsal lateral medullary infarction (LMI) requires long-term tube feeding. However, no study is currently available on therapeutic effectiveness in severe dysphagia caused by nuclear damage of vagus nerve after dorsal LMI. The purpose of the present investigation was to explore the potential of transcutaneous vagus nerve stimulation (tVNS) to improve severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Method We assessed the efficacy of 6-week tVNS in a 28-year-old woman presented with persisting severe dysphagia after dorsal LMI who had been on nasogastric feeding for 6 months. tVNS was applied for 20 min twice a day, 5 days a week, for 6 weeks. The outcome measures included saliva spitted, Swallow Function Scoring System, Functional Oral Intake Scale, Clinical Assessment of Dysphagia With Wallenberg Syndrome, Yale Pharyngeal Residue Severity Rating Scale, and upper esophagus X-ray examination. Results After tVNS, the patient was advanced to a full oral diet without head rotation or spitting. No saliva residue was found in the valleculae and pyriform sinuses. Contrast medium freely passed through the upper esophageal sphincter. Conclusion Our findings suggest that tVNS might provide a useful means for recovery of severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Supplemental Material https://doi.org/10.23641/asha.9755438.
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Affiliation(s)
- Ying Yuan
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jie Wang
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Dongyu Wu
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medical Science, Beijing
| | - Dahua Zhang
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
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Cho YJ, Ryu WS, Lee H, Kim DE, Park JW. Which Factors Affect the Severity of Dysphagia in Lateral Medullary Infarction? Dysphagia 2019; 35:414-418. [PMID: 31375916 DOI: 10.1007/s00455-019-10043-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/02/2019] [Accepted: 07/24/2019] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to identify factors associated with the severity of dysphagia after lateral medullary infarction (LMI). Patients with dysphagia after lateral medullary infarction who were admitted to a rehabilitation unit were included and divided into two groups (non-severe vs. severe). Severe dysphagia was defined as the condition showing decreased bilateral pharyngeal constriction without esophageal passage in a videofluoroscopic swallowing study that initially required enteral tube feeding. Their clinical data (age, sex, lesion side, duration of the illness, penetration-aspiration scale, functional oral intake scale, Modified Barthel index, National Institutes of Health Stroke Scale, and anatomical lesion on diffusion-weighted MRI) were compared to find differences between the two groups. Twelve patients had absence of esophageal passage among a total of 30 patients with dysphagia after LMI. Only anatomical lesion location and extent were significantly different between the two groups. The severe group showed posterolateral involvement in the upper and lower parts of the medulla. Otherwise, there were no significant differences between the two groups. The location and extent of involvement in the medulla were the most important factors associated with the severity of dysphagia after LMI.
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Affiliation(s)
- Yong-Jin Cho
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10326, Republic of Korea
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10326, Republic of Korea
| | - Hojun Lee
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10326, Republic of Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10326, Republic of Korea.
| | - Jin-Woo Park
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10326, Republic of Korea.
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