Successful Treatment of Dysphagia in a Case of Lateral Medullary Syndrome

Abstract

Background: Lateral medullary syndrome is a known cause for apraxia, dysarthria, and dysphagia. It is caused by lesion in the posterolateral area of the medulla oblongata. Dysphagia, being a life-threatening condition, deserves immediate attention of the medical team and is of prime concern to Speech Language Pathologists (SLPs). Aim: The aim of the study was to document a successful case of dysphagia management in lateral medullary syndrome (LMS). Case report: This study documents a successful management of dysphagia in an individual with LMS. Assessment (perceptual and instrumental) showed reduction of peripheral capillary oxygen saturation (SpO2) during feeding, slow laryngeal elevation with pooling of food and saliva in bilateral pyriform fossa, along with a high risk of penetration followed by aspiration. Weak tongue movement and improper lip closure were observed. Combinations of manual therapy and compensatory techniques were used for treating dysphagia. Oromotor exercises and respiratory exercises were used along with supraglottic maneuver, Masako maneuver, chin-tuck with effortful swallow, and Shaker’s exercise. Within 2 weeks of initiation of swallow therapy, the subject could start safe oral intake with pureed food and maintain normal SpO2 level during feeding. Conclusion: This case report demonstrates that dysphagia in LMS can be successfully treated with appropriate selection of combination of techniques in swallow therapy. Supraglottic swallow, Masako maneuver, chin-tuck, and Shaker’s exercise were found effective in this case study. We further conclude that early initiation of therapy is the key to faster recovery. Clinical significance: It is often seen in many of the patients with LMS that they end up with either Rhyle’s tube or percutaneous endoscopic gastrostomy (PEG) tube feeding until complete recovery. This case report highlights the importance of early initiation of therapy and combination of swallowing therapy techniques in order to avoid prolonged artificial tube feeding in these patients. Case RePORt 1,2,4Speech Swallow Pathologist, 3Consultant, 5,6Director 1,2,5,6Department of Neurology, AMRI Hospitals Mukundapur Kolkata, West Bengal, India 3Department of ENT, AMRI Hospitals Mukundapur, Kolkata West Bengal, India 4OKTO Health Care Unit, Kolkata, West Bengal, India Corresponding Author: Bhaskar Dey, Speech Swallow Pathologist, Department of Neurology, AMRI Hospitals Mukundapur, Kolkata, West Bengal, India, Phone: +917980182679 e-mail: dj.bd2009@gmail.com 10.5005/jp-journals-10023-1146