When "Sarcopenic Dysphagia" Is Not the Answer

Area of Science:

• Neurology
• Gastroenterology
• Geriatrics

Background:

• Dysphagia in older adults is often attributed to sarcopenia, a decline in muscle mass and strength.
• Recurrent aspiration pneumonia, weight loss, and reduced physical function prompted an initial diagnosis of sarcopenic dysphagia.

Purpose of the Study:

• To investigate the underlying cause of dysphagia in an elderly patient initially suspected of having sarcopenic dysphagia.
• To evaluate the role of structural abnormalities in the craniovertebral junction contributing to swallowing dysfunction.

Main Methods:

• Flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) were performed.
• Computed tomography (CT) and magnetic resonance imaging (MRI) were utilized to assess craniovertebral alignment and neural structures.

Main Results:

• FEES and VFSS showed delayed swallow initiation, impaired airway reflexes, and reduced pharyngeal sensation.
• VFSS reassessment revealed abnormal craniovertebral alignment, confirmed by CT as atlantoaxial dislocation.
• MRI demonstrated brainstem compression due to superior migration of the odontoid process.

Conclusions:

• This case underscores the importance of considering alternative diagnoses beyond sarcopenia in patients with dysphagia.
• Structural abnormalities, such as atlantoaxial dislocation, can present with swallowing impairments that mimic sarcopenic dysphagia.
• Comprehensive diagnostic evaluation is crucial when clinical presentation and initial assessments are discordant with presumed diagnoses.