Rehabilitation Department, King Abdullah Bin Abdulaziz University Hospital, P.O. Box 47330, Riyadh 11552, Saudi Arabia.
Department of Internal Medicine and Critical Care Neuroscience Division, King Abdullah Bin Abdulaziz University Hospital, P.O. Box 47330, Riyadh 11552, Saudi Arabia.
Int J Environ Res Public Health. 2022 Dec 6;19(23):16329. doi: 10.3390/ijerph192316329.
A 55-year-old male patient with a known medical history of diabetes mellitus type 2 and treated lymphoma was first admitted with a sudden left-sided facial asymmetry and mouth deviation to the left side with no other neurological symptoms. A Computerized Tomography (CT) scan of the brain showed acute infarct and small left basal ganglia old lacunar infarction. He was discharged on a dual antiplatelet. One week later, the patient's condition had worsened and, therefore, was admitted with an impression of ischemic stroke. A bedside swallowing assessment, VFSS, and FEES study were conducted to diagnose this case. The bedside assessment did not reveal any sensory or motor deficits in his oral cavity and the FEES examination was also unable to rule out pharyngeal dysphagia. However, a videofluoroscopic swallowing study (VFSS) revealed a significant dysfunction of oral preparation and oral phases and presented difficulty initiating the pharyngeal phase. Given these features, we believe that this swallowing difficulty is caused by swallowing apraxia. This case provides additional information and understanding on management from the swallowing side.
一位 55 岁男性患者，有 2 型糖尿病的已知病史，曾接受过淋巴瘤治疗，因突发性左侧面部不对称和嘴部向左偏斜而无其他神经系统症状首次入院。脑部计算机断层扫描（CT）显示急性梗死和左侧基底节陈旧腔隙性梗死。他出院时接受了双联抗血小板治疗。一周后，患者病情恶化，因此被诊断为缺血性脑卒中再次入院。进行床边吞咽评估、VFSS 和 FEES 研究以诊断该病例。床边评估未发现口腔有任何感觉或运动缺陷，FEES 检查也无法排除咽部吞咽困难。然而，视频透视吞咽研究（VFSS）显示口腔准备和口腔阶段的功能显著障碍，并在开始咽阶段时出现困难。鉴于这些特征，我们认为这种吞咽困难是由吞咽失用症引起的。这个病例从吞咽方面提供了更多的管理信息和理解。
