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Positional dysphagia secondary to a Chiari I malformation
David L White1, Catherine J Rees, Susan G Butler
1Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Ear, Nose, & Throat Journal
|July 15, 2010
Summary
Positional dysphagia, a new phenomenon, is linked to Chiari I malformation. Surgical decompression resolved symptoms in a patient experiencing swallowing difficulties and aspiration when upright.
Area of Science:
- Neurology
- Gastroenterology
- Otolaryngology
Background:
- Chiari I malformation involves cerebellar tonsil herniation into the spinal canal.
- Dysphagia and aspiration are serious swallowing disorders.
- Positional symptoms in neurological conditions are not fully understood.
Observation:
- A 38-year-old woman presented with progressive dysphagia and cough.
- Swallowing evaluation revealed severe pharyngeal dysphagia and aspiration, particularly when upright.
- Symptoms improved only when the patient assumed a supine position.
Findings:
- Magnetic resonance imaging confirmed Chiari I malformation with cerebellar tonsil herniation to C2 and a cervical syrinx.
- The patient's symptoms were directly related to her posture.
- Surgical decompression of the Chiari I malformation led to complete symptom resolution.
Implications:
- This case highlights positional dysphagia as a potential symptom of Chiari I malformation.
- It underscores the importance of considering positional factors in dysphagia diagnosis.
- Surgical intervention for Chiari I malformation can effectively treat associated positional swallowing dysfunction.
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