Neurology Case Challenge: Drooling and Dysphagia in a Man Who Can’t Speak

Elena Cecilia Rosca, MD, PhD; Cristina Dijmarescu, MD; Mihaela Simu, MD


April 04, 2022

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 78-year-old man is brought to the emergency department by his family owing to sudden onset of an inability to speak or swallow. Three years earlier, he had a left frontal ischemic stroke with right hemiparesis and motor aphasia, from which he had completely recovered.

His history also includes a left cerebellar infarct, asymptomatic lacunar infarcts, stage 3 hypertension, atrial fibrillation, ischemic cardiomyopathy, and dyslipidemia. Current medications include aspirin, ramipril, indapamide, isosorbide dinitrate, digoxin, and rosuvastatin. He does not smoke, drink alcohol, or use illicit drugs.


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