title: Efficacy of botulinum toxin type-A and swallowing treatment for oropharyngeal dysphagia recovery in a patient with lateral medullary syndrome.
abstract: BACKGROUND
  Wallenberg's syndrome (WS) is known as posterior inferior cerebellar artery syndrome. Dysphagia has been reported from 51% to 94% of the patients, ranging from mild to severe.
  
  
  METHODS
  We reported a case of a patient (male; 52 years) with WS. MRI showed an intense hypodense area in the dorsolateral part of the ponto-medullary junction. The clinical signs were severe dysphagia, fed by PEG (FOIS 1; PAS 7), sialorrhea, trismus and ataxia.
  
  
  CONCLUSIONS
  Dysphagia was treated by botulinum toxin type-A (BoNT-A), which was injected into the parotid and submandibular salivary glands, temporalis and masseter muscles, cricopharyngeal muscle associated with specific swallowing exercise and food trails. The 3-months follow-up showed significant saliva reduction and improvement of swallowing to from PEG feeding to consistent oral intake of food (FOIS 3, PAS 5). The treatment with BoNT-A combined with swallowing rehabilitation was fundamental in order to restore the swallowing functions.
authors.affiliation: Neuroriabilitation Hospital Foundation IRCCS San Camillo, Venice, Italy - irene.battel@ospedalesancamillo.net.
authors.forename: Irene
authors.initials: I
authors.lastname: Battel
authors.affiliation: Neuroriabilitation Hospital Foundation IRCCS San Camillo, Venice, Italy.
authors.forename: Isabella
authors.initials: I
authors.lastname: Koch
authors.affiliation: Neuroriabilitation Hospital Foundation IRCCS San Camillo, Venice, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Biddau
authors.affiliation: Neuroriabilitation Hospital Foundation IRCCS San Camillo, Venice, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Carollo
authors.affiliation: Neuroriabilitation Hospital Foundation IRCCS San Camillo, Venice, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Piccione
authors.affiliation: Neuroriabilitation Hospital Foundation IRCCS San Camillo, Venice, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Meneghello
authors.affiliation: Neuroriabilitation Hospital Foundation IRCCS San Camillo, Venice, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Merico
authors.affiliation: Neuroriabilitation Hospital Foundation IRCCS San Camillo, Venice, Italy.
authors.forename: Katie
authors.initials: K
authors.lastname: Palmer
authors.affiliation: Department of Neurosciences and Sense Organs, AO Padua, Padua, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Marchese Ragona
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D005471:Fluoroscopy; D006801:Humans; D015552:Injections, Intralesional; D014854:Lateral Medullary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D019274:Botulinum Toxins, Type A