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Dysphagia CVA Brain Stem

Dysphagia CVA Brain Stem

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Published by drhiwaomer
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case presntation

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Published by: drhiwaomer on Apr 04, 2008
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09/27/2012

original

DYSPHAGIA

ASSISTANT PROFESSOR Dr. Hiwa Omer Ahmed

introduction
• -Sulaiman M.amin Khedar • -55 years old. • -Farmer. • - SUL. –sanggaser.

• Chief complain; • Difficulty of swallowing for the last (2) months duration.

Hx. Of present illness: .Gradual onset of annoying sounds, sensations and decrease hearing capability in the Lt. ear. .Gradual & increasing appearance of difficulty of swallowing, particularly for semi-sold & sold food material. . Coarse & hoarseness of voice. . Drooling of saliva. . All associated with: Poor appetite, loss of weight, dehydration & sleep disturbance.

• • • • • •

Review of systems: .mood changes. .sleep disturbance. .No convulsion. .No dyspnea. . No bowel habits change.

Past medical Hx. : .Immunized. .No Hx. Of allergy to drugs or contrast medium. .No Hx. Of chronic diseases , no smocking or alcoholic. .No Hx. Of recent or chronic drug consumption. .No previous surgical operations. .Hx. of previous admission to (Al-jimhoory Hosp. ) in (hawler ) city at 1993 for TETANUS management.

• O/E : • Middle aged man ,fully conscious, pale,dehydrated,dis comfort,drooling of saliva from the mouth,bovine cough on swallowing.Lt. side facial palsy. • Not cyanosed . • Not jaundiced.

• • • • • • • • • • • • • • • •

Investigations : .Hb% = 10.6 . .W.B.C count = 6.500 . . E.S.R. = 20 . .Blood sugar = 130 . .Blood urea = 18 . . S. Creatinine = 0.8 . .S.G.P.T = 7 . .S.G.O.T = 7 . .S. Alkaline phosphatase = 8 . .S. Cholesterole = 225 . .G. U. E = Normal findings. .Sputum culture = Heavely growth of Staph. areus isolated with sensetivety to streptomycine = ++ ,ampicillin = + . .X-rays of the skull =normal. . U/S of the abdomen = normal . .C.T of the neck & chest = normal

Normal strength lower limbs

Normal strength upper limb

Facial Palsy

FP,ET Feeding

Inability to swallow

Severe conjuctivitis

Pain in Rt shoulder ????,,,

ENDOSCOPY ;
• ENDOSCOPY ; • .pyloric biopsy = no malignancy • . chronic non specific gastritis

E. N.T : consultation
• E. N.T : consultation • . laryngeoscopy : Lt. vocal cord palsy • . no mass . • . no other pathology

SkullX ray

CXR

CXR

Ba meal

2

3

4

CT Scan

M.R.I
• medullo- pontine lesion remain highly suspected ; • M.R.I of the brain indicated ; Retopharyngeal mass possible Angiofibroma ??

CT scan showing Parapharyngeal mass

•THANK

U

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