A Rare Case of Dysphagia with Palatal Tremor

Abstract

Case PresentationA 77-year-old man with a known history of long-standing hypertension experienced a left cerebellar hemorrhage 9 months ago, then a right cerebellar hemorrhage 3 months prior to his presentation. The patient had noticeable dysphagia that required placing a nasogastric tube for nasal feeding. The standardized swallowing assessment revealed that he had an impairment in lip closure, head, and trunk control, pharyngeal reflex, as well as independent coughing. To observe the pathophysiological changes of the pharynx and larynx, a fiberoptic laryngoscope was inserted prior to the video fluoroscopic swallowing study (VFSS), which showed that there was no pathophysiological change. VFSS detected the rhythmic tremor of the soft palate and epiglottis, with residues displayed in the vallecula and pyriform sinuses.Magnetic resonance imaging (MRI) depicted bilateral long T2 signal shadows in the cerebellum, enlargement of the bilateral olivary nucleus, with a longer T2-weighted signal change. The T2 FLAIR image demonstrated an increased signal change, with the right inferior olivary nucleus (ION) obviously larger than the left. (Fig. 1) (9 months after the left cerebellar hemorrhage, 3 months after the right cerebellar hemorrhage).