1
|
Miller ME, Lina I, O'Dell K, Akst LM. Experiences of Patients Living with Retrograde Cricopharyngeal Dysfunction. Laryngoscope 2024; 134:2136-2143. [PMID: 37916795 DOI: 10.1002/lary.31157] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Retrograde cricopharyngeal dysfunction (RCPD) is a newly described condition resulting from failure of cricopharyngeal sphincter relaxation during periods of esophageal distension that results in the inability to burp. Patients' perspectives on symptom experiences, barriers to care, and treatment benefits were investigated. STUDY DESIGN Qualitative semi-structured interviews were conducted with patients diagnosed with RCPD who had been treated with botulinum toxin injection into the cricopharyngeus muscle. Interview questions centered on their experience living with RCPD. Conventional content analysis was performed on interview transcripts. RESULTS Thematic saturation was reached with 13 participants. All participants were diagnosed with RCPD by an otolaryngologist and underwent botulinum toxin injection into the cricopharyngeus muscle with or without dilation of the upper esophageal sphincter in the operating room. Participants described having no memories of ever being able to burp, and all started experiencing RCPD symptoms during adolescence. Patients with RCPD experienced increased social isolation, lost productivity, and worsened mental health. Unanimously, participants first learned about RCPD on social media. All patients were seen by physicians in non-otolaryngology specialties regarding their symptoms prior to learning about their RCPD diagnosis and undergoing treatment by an otolaryngologist. Dilation and chemodenervation resulted in complete resolution of RCPD symptoms for 84.6% of participants. Participants emphasized a desire for more health providers to learn about RCPD and the impact it has on quality-of-life. CONCLUSION(S) The lived experience of patients with RCPD significantly impacts quality of life and is often met with diagnostic barriers in the medical community. Although social media plays a significant role in increasing awareness of RCPD, physician education about the impact of RCPD is essential to improve diagnosis and treatment. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2136-2143, 2024.
Collapse
Affiliation(s)
- Mattea E Miller
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Ioan Lina
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Karla O'Dell
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| |
Collapse
|
2
|
Huang M, Zhang C, Liu Z, Wang J. Commentary: Research trends and hotspots of post-stroke dysphagia rehabilitation: a bibliometric study and visualization analysis. Front Neurosci 2024; 18:1357272. [PMID: 38516309 PMCID: PMC10954896 DOI: 10.3389/fnins.2024.1357272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Affiliation(s)
- Maomao Huang
- Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Rehabilitation Medicine, Southwest Medical University, Luzhou, China
- Rehabilitation Medicine and Engineering Key Laboratory of Luzhou, Luzhou, China
| | - Chunyu Zhang
- Department of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Zige Liu
- School of Clinical Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Jianxiong Wang
- Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Rehabilitation Medicine, Southwest Medical University, Luzhou, China
- Rehabilitation Medicine and Engineering Key Laboratory of Luzhou, Luzhou, China
| |
Collapse
|
3
|
Miller ME, Lina I, Akst LM. Retrograde Cricopharyngeal Dysfunction: A Review. J Clin Med 2024; 13:413. [PMID: 38256547 PMCID: PMC10817096 DOI: 10.3390/jcm13020413] [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: 11/26/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Retrograde cricopharyngeal dysfunction (RCPD), also referred to as retrograde cricopharyngeus dysfunction, is a condition characterized by the inability to burp. The pathophysiology of this condition is thought to result from failure of cricopharyngeal sphincter relaxation during periods of esophageal distension, which leads to patients' bothersome symptoms. RCPD negatively impacts patients' quality of life and is associated with bloating, gurgling, avoidance of carbonation, self-imposed dietary and lifestyle changes designed to minimize discomfort, and flatulence. Complaints often start during adolescence, and many patients search for a diagnosis for years before obtaining treatment. A recent increase in awareness through patient-led social media discussion boards describing the 'no burp' syndrome is leading to an increasing incidence of presentations, often with patients making a self-diagnosis. The increased incidence of RCPD is fueling a larger case series investigating treatment options and outcomes. In this review, we discuss what is known about the pathophysiology of this condition, the otolaryngologic perspective on diagnosis and treatment, the patients' lived experience of this condition, and the influence of social media on RCPD.
Collapse
Affiliation(s)
| | | | - Lee M. Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, 601 N Caroline Street, 6th Floor, Suite 6251, Baltimore, MD 21287, USA; (M.E.M.)
| |
Collapse
|
4
|
Mitchell M, Denna T, Holdgraf R. The kid who couldn't burp: the management of a pediatric case of retrograde cricopharyngeal dysfunction. Proc AMIA Symp 2023; 36:755-757. [PMID: 37829230 PMCID: PMC10566408 DOI: 10.1080/08998280.2023.2255510] [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: 07/31/2023] [Accepted: 08/31/2023] [Indexed: 10/14/2023] Open
Abstract
Retrograde cricopharyngeal dysfunction is a newly described syndrome characterized by the inability to belch, loud abdominal gurgling, excessive flatulence, and pain or distension of the low neck, chest, or abdomen. Treatment is with botulinum toxin injection into the cricopharyngeus muscle. We present a pediatric case of this syndrome to increase awareness among the medical community and for clinicians to expand their index of suspicion for retrograde cricopharyngeal dysfunction.
Collapse
Affiliation(s)
- Matthew Mitchell
- Texas A&M University School of Medicine, College Station, TexasUSA
- Department of Otolaryngology, Baylor Scott & White Medical Center – Temple, Temple, TexasUSA
| | - Travis Denna
- Department of Otolaryngology, Baylor Scott & White Medical Center – Temple, Temple, TexasUSA
| | - Randall Holdgraf
- Department of Otolaryngology, Baylor Scott & White Medical Center – Temple, Temple, TexasUSA
| |
Collapse
|
5
|
Abstract
The gastrointestinal tract is the second largest organ system in the body and is often affected by connective tissue disorders. Scleroderma is the classic rheumatologic disease affecting the esophagus; more than 90% of patients with scleroderma have esophageal involvement. This article highlights esophageal manifestations of scleroderma, focusing on pathogenesis, clinical presentation, diagnostic considerations, and treatment options. In addition, this article briefly reviews the esophageal manifestations of other key connective tissue disorders, including mixed connective tissue disease, myositis, Sjogren syndrome, systemic lupus erythematosus, fibromyalgia, and Ehlers-Danlos syndrome.
Collapse
Affiliation(s)
- Nitin K Ahuja
- Division of Gastroenterology and Hepatology, University of Pennsylvania, 3400 Civic Center Boulevard 7 South Pavilion, Philadelphia, PA 19104, USA
| | - John O Clarke
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 430 Broadway Street, Pavilion C, 3rd Floor, C-343, Redwood City, CA 94063-6341, USA.
| |
Collapse
|
6
|
Ren W, Niu J, Du Y, Jiang H. Hydraulic expansion facilitates remodeling of arteriovenous fistulas without increasing venous intimal hyperplasia in rabbits. ASIAN BIOMED 2021; 15:223-232. [PMID: 37551325 PMCID: PMC10388758 DOI: 10.2478/abm-2021-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background An arteriovenous fistula (AVF) is considered essential for chronic hemodialysis. Objective To determine the effects of hydraulic expansion on the intimal hyperplasia of an AVF. Methods We divided 12 healthy male New Zealand white rabbits into a control group (vein without special handling and direct anastomosis with an artery, n = 6) and a hydraulic expansion group (vein dilated by hydraulic pressure before anastomosis, n = 6). Histopathomorphology was examined with hematoxylin and eosin staining and immunohistochemistry. Analysis of covariance (ANCOVA) was used to compare the data between the groups. Results Immediately and 1 day after surgery, the diameter of the fistula vein in rabbits in the hydraulic expansion group was significantly larger than it was in the control group (P = 0.02 and 0.03 respectively), but not on subsequent days. After hydraulic expansion and before construction of the fistula, the wall of vein was noticeably thinner on macroscopic observation, and the anterior and posterior walls were indistinguishable. At 3 weeks after surgery in the hydraulic expansion group, cells in the vein wall were disordered, there were fewer elastic fibers, tissues from the endothelium to tunica externa were less dense, and there was less extracellular matrix than in the control group. Expression of connective tissue growth factor in the hydraulic expansion group was significantly less than that in the control group (P = 0.01). No differences were found in intimal thickness or immunohistochemistry scores for transforming growth factor-β1 between the groups. Conclusion Hydraulic expansion did not increase intimal hyperplasia of an AVF, but facilitates remodeling of AVFs in rabbits.
Collapse
Affiliation(s)
- Wanjun Ren
- Department of Nephrology and Blood Purification Center, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan250013, Shandong Province, China
| | - Jiyuan Niu
- Department of Nephrology, Linyi Central Hospital, Linyi276400, Shandong Province, China
| | - Yuejuan Du
- Department of Nephrology and Blood Purification Center, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan250013, Shandong Province, China
| | - Huili Jiang
- Department of Nephrology and Blood Purification Center, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan250013, Shandong Province, China
| |
Collapse
|
7
|
Kim MJ, Min YW. [Endoscopic Management of Dysphagia]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 77:77-83. [PMID: 33632998 DOI: 10.4166/kjg.2021.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/03/2022]
Abstract
Dysphagia is difficulty in swallowing that can be caused by a number of disorders that involve either the oropharynx or the esophagus. Specific endoscopic treatment for dysphagia depends on its etiology, whether the dysphagia is caused by mechanical narrowing or a motor disorder. Variable endoscopic treatment strategies can be used to manage dysphagia. Patient with dysfunction of the upper esophageal sphincter may benefit from esophageal dilationor injection of botulinum toxin. Pneumatic balloon dilation, injection of botulinum toxin, peroral endoscopic myotomy can be considered as treatment options for esophageal motility disorders. Endoscopic dilation is the treatment choice of esophageal stricture, while intraluminal steroid injection and temporary stent can be considered in refractory benign esophageal stricture. Self-expandable metal stent insertion can be considered for dysphagia with malignant cause.
Collapse
Affiliation(s)
- Min Ji Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Jo YS, Cha JH, Kim YK, Kim SY, Lee HS. Simultaneous double balloon dilatation using double channel therapeutic endoscope in patients with cricopharyngeal muscle dysfunction: An observative study. Medicine (Baltimore) 2020; 99:e21793. [PMID: 32871899 PMCID: PMC7458264 DOI: 10.1097/md.0000000000021793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The role of endoscopic balloon dilatation (EBD) using double-balloon catheters in patients with cricopharyngeal muscle dysfunction (CPD) is still unclear. Thus, the aim of this study was to compare the functional outcomes between patients receiving EBD and rehabilitative balloon swallowing (RBS).A total of 36 patients with CPD, who visited a teaching hospital from February 2014 to June 2017, were included in the study. Among them, 12 patients with severe dysphagia underwent EBD. After propensity score matching, 24 patients who underwent RBS were selected for comparison. We compared the effects of EBD and RBS using 4 functional swallowing parameters: functional dysphagia scale score, penetration-aspiration scale score, pharyngeal transit time, and percentage of pharyngeal remnant (PR) at baseline and after the first and second treatments. Using simple and multiple regression, we examined the associations between EBD/RBS and changes of 4 parameters after the treatments since the baselineAll functional parameters significantly decreased after RBS and EBD (P < .05). After the first therapy session, significant differences in the pharyngeal transit time (P = .034), percentage of PR (P = .008), and penetration-aspiration scale score (P = .014) were observed in the EBD group, compared with those in the RBS group. The regression analysis showed significant improvements in the PR after EBD compared with that after RBS (β = 0.95, SE = 0.31, P = .005).EBD may be an alternative treatment for patients with severe CPD. A significant improvement would be expected in such patients with PR.
Collapse
Affiliation(s)
- Yong Seob Jo
- Department of Physical Medicine and Rehabilitation, Myongji Hospital
| | - Jung Hyun Cha
- Department of Physical Medicine and Rehabilitation, Myongji Hospital
| | - Yong Kyun Kim
- Department of Physical Medicine and Rehabilitation, Myongji Hospital
| | - Sun Young Kim
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang
| | - Hong Sub Lee
- Department of Internal medicine, Inje University Busan Paik Hospital, Busan, Korea
| |
Collapse
|
9
|
Boppana V, SantaCruz K, Shrestha M, Volpicelli N, McCarthy D. Bar None: A Rare Cause of Oropharyngeal Dysphagia. Dig Dis Sci 2020; 65:1656-1660. [PMID: 32350722 DOI: 10.1007/s10620-020-06274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Vaishnavi Boppana
- Department of Internal Medicine, UNMHSC, University of New Mexico School of Medicine, MSC10 5550, Albuquerque, NM, 87131, USA.
| | - Karen SantaCruz
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Manish Shrestha
- Divisions of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Nicholas Volpicelli
- Divisions of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Denis McCarthy
- Divisions of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| |
Collapse
|
10
|
Kang SH, Kim JS, Joo JS, Eun HS, Lee ES, Moon HS, Kim SH, Sung JK, Lee BS, Jeong HY, Kim Y, Sohn MK, Jee S. Efficacy of Early Endoscopic Intervention for Restoring Normal Swallowing Function in Patients with Lateral Medullary Infarction. Toxins (Basel) 2019; 11:toxins11030144. [PMID: 30836597 PMCID: PMC6468434 DOI: 10.3390/toxins11030144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/11/2019] [Accepted: 02/19/2019] [Indexed: 11/16/2022] Open
Abstract
Dysphagia is considered to be a significant barrier for recovery after lateral medullary infarction (LMI). However, there is still no gold standard treatment for dysphagia. The aim of this study was to explore an effect of an early treatment options for swallowing dysfunction after acute LMI. Medical records of acute LMI patients who had been admitted to the department of rehabilitation medicine from January 2014 to December 2017 were reviewed retrospectively. We compared the clinical efficacy of conventional dysphagia rehabilitation to early endoscopic intervention using either botulinum toxin injection into cricopharyngeal muscle or endoscopic balloon dilatation of the muscle. Outcomes, such as duration of parental feeding, albumin level at diet transition to enteral feeding, and complications, were analyzed. A total of 18 patients with LMI were included. While eight patients (8/9, 88.89%) in the endoscopic group were capable of orally ingesting their diet after intervention, the conversion from tube feeding to an oral diet was possible in only five patients (5/9, 55.56%) of the conventional group during hospitalization. However, the difference between the two groups was not significant (p-value ≤ 0.147, chi-square test). Only the final dietary level at the time of discharge was higher level in endoscopic group. The conversion interval from tube feeding to oral diet was also comparable between groups. There was no re-conversion from the oral diet to tube feeding in patients of either group during the median follow-up period of 20 months. Early endoscopic intervention may be a better option for dysphagia with LMI, compared to conventional dysphagia rehabilitation. However, a larger and prospective trial may be needed to confirm our observations.
Collapse
Affiliation(s)
- Sun Hyung Kang
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Ju Seok Kim
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Jong Seok Joo
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Hyuk Soo Eun
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Eaum Seok Lee
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Hee Seok Moon
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Seok Hyun Kim
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Jae Kyu Sung
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Byung Seok Lee
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Hyun Yong Jeong
- Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
| | - Yeongwook Kim
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
- Daejeon-Chungnam Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon 35015, Korea.
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
- Daejeon-Chungnam Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon 35015, Korea.
| | - Sungju Jee
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Korea.
- Daejeon-Chungnam Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon 35015, Korea.
| |
Collapse
|
11
|
Wei P, Xu Y, Zhang Z, Zhang S, Lv Z. Treatment for upper esophageal sphincter dysfunction in a patient with poststroke dysphagia: A case report. Medicine (Baltimore) 2019; 98:e14988. [PMID: 30921211 PMCID: PMC6455981 DOI: 10.1097/md.0000000000014988] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE Botulinum toxin injection is a widely used procedure for the treatment of the dysfunction of the upper esophageal sphincter (UES). Although the injection can be guided by ultrasound, electromyography, or computed tomography, such techniques cannot determine the exact extent of narrowed UES and ensure that the narrowed extent is fully covered by the treatment. This report describes a dual guiding technique with ultrasound and the balloon catheter in a patient with poststroke dysphagia to improve these weaknesses. PATIENT CONCERNS The patient was admitted to a rehabilitation hospital 2 weeks postcerebral infarction. DIAGNOSES Clinical presentation of the patient included severe hemiplegia and dysphagia. The fiberoptic endoscopic evaluation of swallowing (FEES) revealed penetration/aspiration when swallowing 1 ml water and 1 ml yogurt and pooling in the postcricoid region. INTERVENTIONS Balloon catheter dilatation procedures and Botulinum toxin injection were performed. We used a dual guiding technique with ultrasound and the balloon catheter to determine the whole segment of UES dysfunction by locating the lowest level of the impaired UES opening and to reduce difficulty in differentiating UES from adjacent tissues during Botulinum toxin injection. OUTCOMES No persistent progress was observed on the symptoms and volume of the balloon during dilatation. The patient showed quick responses after Botulinum toxin injection. The postinjection balloon catheter dilatation showed an increased maximum volume (preinjection, 5.5 ml vs. postinjection, 14 ml), and the patient was able to eat yogurt, congee, or semi-solid food 100-150 ml 4 weeks after the injection. LESSONS The dual guiding method holds several advantages, suggesting that it may be considered as a promising choice in dealing with UES dysfunction.
Collapse
|
12
|
Yoneoka Y, Ikeda R, Aizawa N, Seki Y, Akiyama K. Medial pontomedullary junctional infarction presenting vertigo, ipsilateral facial paresis, contralateral thermal hypoalgesia and dysphagia without lateral gaze palsy, curtain sign and hoarseness: a case presentation of a novel brain stem stroke syndrome with sensory disturbance-based dysphagia and review of the literature. Oxf Med Case Reports 2019; 2019:omy121. [PMID: 30697437 PMCID: PMC6345094 DOI: 10.1093/omcr/omy121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/01/2018] [Accepted: 11/07/2018] [Indexed: 11/12/2022] Open
Abstract
In this report, we describe unilateral medial pontomedullary junction (MPMJ) syndrome as a novel brain stem stroke syndrome. A 68-year-old woman suddenly developed vertigo, ipsilateral facial paresis, contralateral thermal hypoalgesia (TH) and dysphagia without lateral gaze palsy, curtain sign and hoarseness. Magnetic resonance (MR) imaging showed a small infarction at the right MPMJ. MR angiography did not show vertebrobasilar arterial dissection, thrombosis or vasospasm. Finally, her dysphagia regressed over 4 weeks in synchronization with recovery of TH. To the best of our knowledge and based on a review of the literature, this MPMJ syndrome associated with the unilateral MPMJ infarction is a novel brain stem stroke syndrome different from Foville syndrome, Millard–Gubler syndrome, Wallenberg syndrome or Dejerine’s syndrome. In the MPMJ syndrome, transient, albeit severe, dysphagia based on the TH-impaired swallowing reflex bothered the patient more than hemiparesthesia of TH did.
Collapse
Affiliation(s)
- Yuichiro Yoneoka
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Ryo Ikeda
- Department of Otorhinolaryngology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Naotaka Aizawa
- Department of Otorhinolaryngology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yasuhiro Seki
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Katsuhiko Akiyama
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| |
Collapse
|
13
|
Patel RV, Hirano I. Endoscopic diagnosis and treatment of disorders of upper esophageal sphincter function. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2018. [DOI: 10.1016/j.tgie.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|