["Palatolaryngeal hemiplegia" in transient brain stem ischemia--a contribution to neurogenic dysphagia]

A 65-year old man suffering from dysphagia with aspiration was examined. ENT examination showed a Horner syndrome and cranial nerve palsy with paralysis of the soft palate and one vocal cord (palatolaryngeal hemiplegia, Avellis' syndrome). Pharyngeal manometry and videofluoroscopy depicted an asynergic swallowing with cricopharyngeal achalasia. CT scans of mediastinum, head, neck, and skull base showed no signs of abnormality. MR imaging of the brain stem demonstrated an enrichment of contrast medium in the dorsal region of the upper medulla oblongata in the level of the centre of the glossopharyngeal and vagus nerve. This case demonstrates an uncommon cause of dysphagia which was related to transitory brain stem ischaemia. After a period of three weeks the patients' complaints vanished as well as the clinical features. In a follow-up of MR-imaging three months later no focal enhancement of contrast medium was seen confirming the diagnosis of a brain stem ischaemic lesion.