Pediatric Medullary Stroke, Severe Dysphagia, and Multimodal Intervention

Area of Science:

• Neurology
• Pediatric Neurology
• Gastroenterology

Background:

• Lateral medullary syndrome (Wallenberg syndrome) is a rare pediatric brainstem stroke.
• It commonly affects swallowing centers and cranial nerves, leading to severe dysphagia and aspiration.
• 22q11.2 deletion syndrome is associated with velopharyngeal insufficiency and surgical complications.

Observation:

• A 7-year-old male with 22q11.2 deletion syndrome experienced a dorsal medullary stroke post-surgery.
• The stroke resulted in severe dysphagia, absent upper esophageal sphincter (UES) opening, and aspiration.
• The patient required prolonged intensive care, tracheostomy, and gastrostomy tube feeding.

Findings:

• Comprehensive swallowing evaluations (VFSS, FEES, manometry) were performed.
• Interventions included intensive speech therapy, cricopharyngeal Botox injection, and cricopharyngeal myotomy.
• Nineteen months post-stroke, the patient achieved functional oral intake without aspiration.

Implications:

• This case highlights successful multidisciplinary management of pediatric brainstem stroke-induced dysphagia.
• Early and aggressive intervention can lead to significant functional recovery in swallowing.
• Understanding the complex interplay of neurological deficits and surgical complications is crucial for pediatric stroke management.