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急性吞咽困难:外侧延髓综合征罕见的首发症状:一例报告

Acute dysphagia: A rare initial symptom of lateral medullary syndrome: A case report.

作者信息

Ali Farhan, Zubair Amraha, Nazir Fatima, Ali Kashif, Mansoor Sobia

机构信息

Department of Internal Medicine, Chandka Medical College Hospital, Shah Nawaz Bhutto road, Larkana city, Sindh, 77170, Pakistan.

Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Mission Rd, Nanak Wara Nanakwara, Karachi City, Sindh, 74200, Pakistan.

出版信息

Ann Med Surg (Lond). 2022 Nov 8;84:104851. doi: 10.1016/j.amsu.2022.104851. eCollection 2022 Dec.

Abstract

INTRODUCTION AND IMPORTANCE

A unique etiology of stroke, lateral medullary syndrome (LMS), is a consequence of posterior inferior cerebellar artery or vertebral artery thromboembolic conditions. LMS patients present particularly with ipsilateral hyperalgesia, ipsilateral ataxia, and Horner's syndrome. Our case signifies that neurogenic origin should always be considered in the absence of local causes of dysphagia. Early diagnosis could prevent LMS complications, including neurological disabilities. A scarcity of research related to dysphagia in LMS, and its outcomes exists. Therefore, the objective is to investigate the clinical course in a patient afflicted with severe dysphagia following a diagnosis of (LMS). This would encourage further research, thus improving management and treatment strategies.

CASE PRESENTATION

We report a case of a 45-year-old male, a smoker for 20 years, who presented with a single, unique complaint of acute dysphagia for 9 days. According to our knowledge, this is among very few reported cases of LMS with dysphagia being the rare initial complaint. The neurological issues associated with dysphagia gradually improved with the administration of antiplatelet; clopidogrel and lipid-lowering drug; rosuvastatin and the patient was discharged. Atypical presentation in LMS could be supported by the presence of lateral medullary infarct which was confirmed by MRI (Magnetic Resonance Imaging).

CLINICAL DISCUSSION

Dysphagia is a common complaint in multiple gastrointestinal (GI) settings. However, in cases where the GI causes are excluded, as described here, diagnosis of LMS becomes tough.

CONCLUSION

The diagnosis of LMS was queried owing to the presentation of the single most important common symptom, with no other characteristic manifestations of LMS.

摘要

引言与重要性

一种独特的中风病因,即延髓外侧综合征(LMS),是小脑后下动脉或椎动脉血栓栓塞情况的结果。LMS患者尤其表现为同侧痛觉过敏、同侧共济失调和霍纳综合征。我们的病例表明,在没有吞咽困难局部病因的情况下,应始终考虑神经源性病因。早期诊断可预防LMS并发症,包括神经功能障碍。关于LMS中吞咽困难及其后果的研究稀缺。因此,目的是调查一名诊断为(LMS)后患有严重吞咽困难患者的临床病程。这将鼓励进一步研究,从而改善管理和治疗策略。

病例介绍

我们报告一例45岁男性,有20年吸烟史,他唯一的独特主诉是急性吞咽困难9天。据我们所知,这是极少数以吞咽困难为罕见初始主诉的LMS报道病例之一。与吞咽困难相关的神经问题通过使用抗血小板药物氯吡格雷和降脂药物瑞舒伐他汀逐渐改善,患者出院。LMS的非典型表现可通过MRI(磁共振成像)证实的延髓外侧梗死来支持。

临床讨论

吞咽困难是多种胃肠道(GI)疾病中的常见主诉。然而,如本文所述,在排除GI病因的情况下,LMS的诊断变得困难。

结论

由于出现了LMS最重要的常见单一症状,且无LMS的其他特征性表现,对LMS进行了诊断询问。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ed37/9793181/0a67a3ad140a/gr1.jpg

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