Neuroriabilitation Hospital Foundation IRCCS San Camillo, Venice, Italy -
Neuroriabilitation Hospital Foundation IRCCS San Camillo, Venice, Italy.
Eur J Phys Rehabil Med. 2017 Oct;53(5):798-801. doi: 10.23736/S1973-9087.17.04499-9. Epub 2017 Mar 6.
Wallenberg's syndrome (WS) is known as posterior inferior cerebellar artery syndrome. Dysphagia has been reported from 51% to 94% of the patients, ranging from mild to severe.
We reported a case of a patient (male; 52 years) with WS. MRI showed an intense hypodense area in the dorsolateral part of the ponto-medullary junction. The clinical signs were severe dysphagia, fed by PEG (FOIS 1; PAS 7), sialorrhea, trismus and ataxia.
Dysphagia was treated by botulinum toxin type-A (BoNT-A), which was injected into the parotid and submandibular salivary glands, temporalis and masseter muscles, cricopharyngeal muscle associated with specific swallowing exercise and food trails. The 3-months follow-up showed significant saliva reduction and improvement of swallowing to from PEG feeding to consistent oral intake of food (FOIS 3, PAS 5). The treatment with BoNT-A combined with swallowing rehabilitation was fundamental in order to restore the swallowing functions.
延髓外侧综合征（Wallenberg's syndrome，WS）又称小脑后下动脉综合征。吞咽困难在 51%至 94%的患者中均有报道，严重程度不一。
我们报告了一例 WS 患者（男性，52 岁）。MRI 显示桥延髓结合部背外侧有强烈的低信号区。临床症状为严重吞咽困难，需经 PEG 喂养（FOIS 1；PAS 7），流涎，牙关紧闭和共济失调。
吞咽困难通过肉毒毒素 A（BoNT-A）治疗，将 BoNT-A 注射到腮腺和颌下腺、颞肌和咬肌、环咽肌，并结合特定的吞咽运动和食物追踪。3 个月随访显示唾液明显减少，吞咽功能从 PEG 喂养改善至能持续经口摄入食物（FOIS 3，PAS 5）。BoNT-A 联合吞咽康复治疗对于恢复吞咽功能至关重要。
