Pediatric Medullary Stroke, Severe Dysphagia, and Multimodal Intervention
Autor: | Caroline Ivie, Nikhila Raol, Steven L. Goudy, Laura Brooks |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Adult
Male medicine.medical_specialty Brain Stem Infarctions Pharyngeal flap surgery Manometry Speech and Hearing Swallowing Medullary stroke Intensive care Clinical Conundrum otorhinolaryngologic diseases Medicine Humans Child Stroke Lateral Medullary Syndrome Lateral medullary syndrome business.industry Pharyngeal and esophageal manometry Pediatric dysphagia Pharynx Gastroenterology medicine.disease Esophageal Sphincter Upper Dysphagia Surgery Deglutition medicine.anatomical_structure Otorhinolaryngology Cricopharyngeal myotomy medicine.symptom business Deglutition Disorders |
Zdroj: | Dysphagia |
ISSN: | 1432-0460 0179-051X |
Popis: | Lateral medullary syndrome/Wallenberg syndrome is a stroke in the lateral medulla with symptoms often including dysphagia and dysphonia. In adults, this stroke is the most common brainstem stroke, but it is rare in the pediatric population. Insults to the medulla can involve the "swallowing centers," the nucleus ambiguus and nucleus tractus solitarius, and the cranial nerves involved in swallowing, namely IX (glossopharyngeal) and X (vagus). These individuals can develop severe dysphagia with an inability to trigger a swallow due to pharyngeal weakness and impaired mechanical opening of the upper esophageal sphincter (UES) which can result in aspiration. We present a 7-year-old male with 22q11.2 deletion syndrome (velocardiofacial syndrome) and velopharyngeal insufficiency who underwent pharyngeal flap surgery at an outside hospital whose post-operative course was complicated by adenovirus, viral myocarditis, and dorsal medullary stroke. He required a tracheostomy and gastrostomy tube. He was discharged from that hospital and readmitted to our hospital 4 months later for increased oxygen requirement, requiring a 5 month admission in the intensive care units. His initial VFSS revealed absent UES opening with the entire bolus remaining in the pyriform sinuses resulting in aspiration. His workup over the course of his admission included multiple videofluoroscopic swallow studies (VFSS), flexible endoscopic evaluation of swallowing (FEES), and pharyngeal and esophageal manometry. Intervention included intensive speech therapy, cricopharyngeal Botox® injection, and cricopharyngeal myotomy. Nineteen months after his stroke, he transitioned to oral intake of solids and liquids with adequate movement of the bolus through the pharynx and UES and no aspiration on his VFSS. |
Databáze: | OpenAIRE |
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