Wallenberg syndrome associated with hysteria: A case report

Abstract

Rationale: Wallenberg syndrome, also referred to as posterior inferior cerebellar artery syndrome, represents the most prevalent form of bulbar syndrome and typically arises from occlusion of the posterior inferior cerebellar artery or its perforator artery. This vascular impairment can result in profound dysphagia, significantly compromising both survival time and quality of life for stroke survivors. Managing swallowing disorders associated with Wallenberg syndrome alone poses considerable challenges, while diagnosing and treating complex swallowing disorders stemming from other etiologies present formidable obstacles for clinicians and rehabilitation therapists alike. Naturally, such intricate swallowing disorders are infrequently encountered in clinical practice. Patient concerns: The dysphagia experienced by a 60-year-old Asian male with right medulla infarction was severe, rendering him unable to swallow any food or saliva. However, unlike typical bulbar palsy patients, these individuals exhibit functional dysphagia disorders in addition to neurodysphagia. Notably, there is no damage observed in the brain’s cognitive areas; however, evident cognitive impairment related to swallowing is present. Diagnosis: Swallowing disorders associated with Wallenberg syndrome, in conjunction with swallowing hysteria syndrome, were examined. Interventions: Cognitive training incorporating mirror swallowing techniques, high‐intensity electrical stimulation, and balloon expansion therapy. Outcomes: Following treatment, the patient swiftly regained normal swallowing function within a span of 21 days, and this functionality was sustained during the six-month follow-up period. Lessons: Wallenberg syndrome frequently presents with severe dysphagia, characterized by complex and debilitating symptoms, resulting in a poor prognosis. Due to the prolonged requirement of nasogastric feeding even after treatment, alternative etiologies for dysphagia are often overlooked. Isolated hysterical swallowing syndrome is relatively uncommon in clinical practice, particularly when coexisting with Wallenberg syndrome; however, fortunately, it exhibits a more favorable recovery outcome. The objective of this case report is to prompt clinicians and rehabilitation therapists to consider other potential causes of swallowing disorders in patients with Wallenberg syndrome when conventional treatments prove ineffective, thereby enhancing the rehabilitative outcomes for these individuals.