title: Velopharyngeal incompetence as the presenting symptom of malignant brainstem tumor.
abstract: OBJECTIVE
  When a patient presents with velopharyngeal incompetence (VPI) without an obvious structural or neurologic cause, the clinician is faced with a diagnostic challenge. We present an 11-year-old male with a long history of VPI who had been referred to our institution for evaluation and treatment.
  
  
  RESULTS
  Detailed clinical examination and work-up revealed a malignant brainstem tumor. The presenting symptoms of breathiness associated with VPI had been overlooked by several different clinicians in the past. The patient successfully underwent a sphincter pharyngoplasty.
  
  
  CONCLUSIONS
  A careful neurologic examination with special attention to the cranial nerves is necessary to identify subtle neurologic deficits and avoid delay in diagnosis. Differential diagnosis of neurogenic VPI is discussed.
authors.affiliation: Speech Pathology Laboratory, Scottish Rite Children's Medical Center, Atlanta, Georgia 30342, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Lefaivre
authors.forename: S R
authors.initials: SR
authors.lastname: Cohen
authors.forename: J E
authors.initials: JE
authors.lastname: Riski
authors.forename: F D
authors.initials: FD
authors.lastname: Burstein
mesh_terms: D001932:Brain Neoplasms / Q000150:complications*; D001933:Brain Stem / Q000473:pathology*; D002648:Child; D003937:Diagnosis, Differential; D005910:Glioma / Q000150:complications*; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D010609:Pharyngeal Muscles / Q000601:surgery; D012017:Referral and Consultation; D013064:Speech Disorders / Q000209:etiology; D014681:Velopharyngeal Insufficiency / Q000209:etiology* / Q000601:surgery; D014826:Vocal Cord Paralysis / Q000209:etiology