Isolated Swallowing Disorders in a Patient with Medial Medullary Infarction : A Case Report

Swallowing disorders are common in brainstem strokes but rarely occur in isolation. Medial medullary infarction (MMI) typically presents with multiple neurological deficits, making isolated dysphagia an uncommon presentation. We report a 48-year-old man admitted 2 hours after symptom onset with sudden severe dysphagia, without other neurological symptoms (NIHSS = 0). Examination revealed an absent gag reflex on the left side. Brain MRI showed an acute infarction of the left medial medulla, with diffusion restriction and no FLAIR abnormality, consistent with hyperacute ischemia. Thrombolysis was not performed after risk–benefit assessment. The patient was treated with antiplatelet therapy and underwent swallowing rehabilitation, with complete recovery after two weeks. This case highlights that isolated dysphagia may be the sole manifestation of MMI. Despite a low NIHSS score, such presentations may be functionally disabling, requiring early recognition and appropriate management.