Dysphagia as the Sole Presentation of Lateral Medullary Syndrome in an Octagerian: A Diagnostic Challenge

ABSTRACT Lateral medullary syndrome (LMS) or Wallenberg's syndrome is usually caused by a cerebrovascular accident of the vertebral artery or the posterior inferior cerebellar artery (PICA), leading to damage to the dorsolateral aspects of the medulla oblongata. Its clinical presentation includes vertigo, nystagmus, diplopia, dysphagia, dysarthria, ipsilateral Horner's syndrome, cerebellar ataxia, and sensory disturbance. LMS with sole presentation of dysphagia is rare. We report the case of an eighty‐year‐old hypertensive male patient with a sudden onset of isolated dysphagia posing a diagnostic challenge to undergo a series of investigations to reach a final diagnosis of LMS. He presented with difficulty of swallowing for both liquid and solid food. Neurological examination revealed poor gag reflex and left‐side uvula deviation. Initial investigations including upper GI endoscopy, Brain CT scan, Chest X‐ray, ECG, echocardiography, and cranial Doppler ultrasound all yielded unremarkable results. Finally, a left lateral medullary infarct was detected on MRI. The patient was treated with an NG tube, and secondary prevention was initiated. The symptoms resolved during the two‐month follow‐up. Swallowing difficulties commonly occur due to mechanical obstruction arising from pathologies of the oropharynx and esophagus. Identifying neurological origins, such as lateral medullary syndrome, especially in the setting of an isolated presentation of dysphagia, could be complex and challenging leading physicians to unnecessary investigations; thus, a high degree of clinical suspicion is essential.