Cerebellar Repetitive Transcranial Magnetic Stimulation (rTMS) With Modified Proprioceptive Neuromuscular Facilitation (PNF) Balloon Dilation for Dysphagia After Brainstem and Cerebellar Infarction: A Case Report

Dysphagia resulting from bilateral cerebellar and brainstem infarction represents one of the most severe and challenging subtypes of post-stroke dysphagia in clinical practice. This study reports a case involving the application of cerebellar repetitive transcranial magnetic stimulation (rTMS) combined with modified proprioceptive neuromuscular facilitation (PNF)-guided balloon dilation therapy for dysphagia in a patient with bilateral cerebellar and brainstem infarction. The patient resumed full oral intake for all three daily meals and was able to drink fluids independently. A three-month follow-up confirmed sustained normal swallowing function with no signs of recurrence. The innovative "central-peripheral" combined therapeutic approach proposed in this study may represent a promising therapeutic option for the management of severe dysphagia following infratentorial stroke. This study aimed to detail the swallowing function recovery process in a patient with severe post-stroke dysphagia (PSD) resulting from bilateral posterior cerebellar lobe infarction combined with brainstem infarction, following comprehensive intervention integrating cerebellar rTMS (central neuromodulation) and modified PNF-synchronized catheter balloon dilation (peripheral functional remodeling). Through this case, we seek to explore the feasibility, safety, and potential therapeutic efficacy of this combined regimen for such complex PSD. It is intended to provide novel clinical insights and practical evidence for developing individualized and precise swallowing rehabilitation strategies in the future.