Multiple lower cranial nerves palsy induced by inflammatory lesion: A Case Report

초록

Introduction Swallowing disorder is mainly observed in stroke, brain injury, tumors, and radiation therapy etc. Additionally, infection or abnormality of the immune system is reported rarely. We aim to report a case of multiple lower cranial neuropathy associated with dysphagia after upper respiratory infection. Case A 65-year-old woman was admitted to otolaryngology department due to dysphagia and hoarseness. Her medical history was hypertension, DM, and rheumatoid arthritis. She had upper respiratory infection before dysphagia and voice change. Left vocal cord paralysis with intact airway patency was shown using laryngoscopy (Fig. 1 (a)) Video-fluoroscopic swallowing study (VFSS) showed aspiration after swallowing phase due to residue in vallecula space and pyriform sinus with cough, and also observed markedly decreased pharyngeal peristalsis and velopharyngeal insufficiency in pharyngeal phase (Fig. 1 (b)). Inner ear MRI showed asymmetric mild nerve thickening in cisternal segment of left CN X/XI, glossopharyngeal sulcus area and pars nervosa of jugular foramen on FLAIR and enhanced SPPGR image and prominent venous plexus in root exit zone area of CN IX, X,XII. These findings were correlated with inflammatory condition such as neuritis (Fig. 2). In nerve conduction study (NCS), cranial nerves (VII, XI), blink reflexes were within normal limits. Both upper and lower extremities NCS were normal. On electromyography, abnormal spontaneous activities with motor unit changes were noted at left thyroarytenoid, sternocleidomastoid, and tongue muscles. (Table 1)