Sie können Operatoren mit Ihrer Suchanfrage kombinieren, um diese noch präziser einzugrenzen. Klicken Sie auf den Suchoperator, um eine Erklärung seiner Funktionsweise anzuzeigen.
Findet Dokumente, in denen beide Begriffe in beliebiger Reihenfolge innerhalb von maximal n Worten zueinander stehen. Empfehlung: Wählen Sie zwischen 15 und 30 als maximale Wortanzahl (z.B. NEAR(hybrid, antrieb, 20)).
Findet Dokumente, in denen der Begriff in Wortvarianten vorkommt, wobei diese VOR, HINTER oder VOR und HINTER dem Suchbegriff anschließen können (z.B., leichtbau*, *leichtbau, *leichtbau*).
An 80-year-old patient reported unwanted weight loss of 20 kg and difficulty swallowing for 2 years. He also had to cough frequently when eating. In the neurological examination there were no definite deficits of the cranial nerves. The tongue had a strong muscle relief, no definite fasciculations, the soft palate was well elevated, the pharyngeal reflex could be triggered laterally. The voice sounded slightly labored. There was no limb paresis and no ataxia. No fasciculations were visible or provocable. The muscle reflexes were equal. There were no pyramidal tract signs. Standing and walking in the room were unremarkable. Neuromuscular testing and the antibody profile showed no myasthenia gravis. The patient did not have arterial hypertension. There were also no anamnestic or clinical hints of a congenital disorder such as Marfan syndrome or Fabry disease. Gastroscopy and ear, nose and throat examinations were unremarkable. Dynamic pharyngoesophagography revealed delayed swallowing reflex triggering and reduced elevation and ventral movement of the hypolaryngeal complex. Fiber endoscopic evaluation of the act of swallowing (FEES) showed spontaneous accumulation of saliva in the hypopharynx, valleculae and piriform sinus (Fig. 1a). In addition, moderate vallecular residue by two consistencies (solid, pureed) and a postdeglutitive aspiration were present. Cranial MR-tomography using an open 1 T scanner demonstrated an enlarged transverse left vertebral artery (dolicho-vertebral artery) at the level of the foramen magnum with dorsal compression and slight kinking of the medulla oblongata (Fig. 1b–d). Neurogenic dysphagia due to compression of the medulla oblongata by the left enlarged and enlongated vertebral artery was diagnosed. As the patient refused neurosurgical decompression swallowing therapy was instructed.
Fig. 1
a Snapshot during fiber endosopic examination of the swallowing (FEES) with pronounced accumulation of unswallowed periepiglottic saliva. b Coronar T1-weighted magnetic resonance imaging (MRI) with enlarged and elongated left vertebral artery (white arrowheads) crossing and displacing the medulla oblongata. c Axial T2-weighted MRI with enlarged transverse vertebral artery (black arrowheads) leading to touching and compression of the medulla oblongata. d Sagittal T1-weighted MRI in the midline. The transverse crossing vertebral artery (arrow) displaces the medulla oblongata and bends it slightly. e Schematic drawing of the proposed pathophysiological mechanism by sagittal view on the midline brainstem. The enlarged vertebral artery (VA) compresses the brainstem at the level of the dorsal and ventral swallowing centers (SC)
