J Korean Dysphagia Soc.  2024 Jan;14(1):54-58. 10.34160/jkds.23.009.

Natural Course of Diffusion-Weighted Image-Negative Stroke Dysphagia: A Case Report

• Cho HW
• Kim MS
• Kim YJ
• Kim YJ
• Jung SJ
• Park J

• KMID: 2559396
• DOI: http://doi.org/10.34160/jkds.23.009

Abstract

This study reports serial swallowing functional changes in a patient with an acute ischemic stroke but normal diffusion weighted imaging (DWI) scans. A 71-year-old man presented with dysphagia. Laryngoscopy revealed left arytenoid swelling and hypomobility of the left vocal cord. Acute lesions were not observed on brain magnetic resonance imaging. On the 9th day following hospital admission, the first videofluoroscopic swallowing study (VFSS) was performed. When he swallowed semi-solid food, significant pre- and post-swallowing aspirations were detected without coughing. An acute stroke with sudden-onset dysphagia was considered as the possible cause of dysphagia. The serial VFSSs showed gradual improvement in the swallowing reflex and persistent moderate cricopharyngeal dysfunction. During the VFSS anteroposterior view, bolus swallowing was tolerated, and aspiration signs disappeared, as the head was turned to the left and tilted to the right, indicating the role of a lateralizing lesion in symptom onset. This case study reports the course of natural resolution of dysphagia in a patient with a DWI-negative stroke based on serial VFSS results. There is a need to establish the significance of intensive dysphagia rehabilitation, including neuromuscular electrical stimulation therapy, in patients clinically diagnosed with an acute stroke. Therefore, further studies involving a larger population of patients with DWI-negative strokes and dysphagia are warranted.

Keyword

Deglutition disorders; Diffusion magnetic resonance imaging; Stroke; Stroke rehabilitation