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A Dorsolateral Medullary Infarct Presenting with Isolated Dysphagia
Justin Pathickal1, Emilissa Domingo2, Anne Dulski3
1Kent Hospital Emergency Medicine Residency Program, Warwick, RI.
Rhode Island Medical Journal (2013)
|August 29, 2023
Summary
Posterior circulation stroke, a common cause of brain ischemia, can present atypically. This case highlights a dorsolateral medullary stroke with dysphagia but no dizziness, emphasizing the need for advanced imaging.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Posterior circulation cerebrovascular events account for about 20% of all ischemic strokes.
- Typical symptoms include dizziness, ataxia, and gait disturbances.
- Dizziness is a common presentation in the majority of posterior circulation stroke cases.
Observation:
- This case report details a patient with a dorsolateral medullary stroke.
- The patient presented atypically with dysphagia (difficulty swallowing).
- Crucially, the patient experienced no dizziness or ataxia, which are common stroke symptoms.
Findings:
- Initial computed tomography (CT) scans did not reveal large vessel occlusion or acute infarct.
- Magnetic resonance imaging (MRI) confirmed a right dorsolateral medullary infarct.
- The findings underscore the limitations of initial CT in detecting certain posterior circulation strokes.
Implications:
- Atypical presentations of posterior circulation strokes can be missed by initial non-contrast CT.
- Advanced neuroimaging like MRI is crucial for accurate diagnosis of medullary infarcts.
- Dysphagia in stroke patients increases the risk of aspiration and pneumonia, requiring prompt management.
