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

Amyotrophic lateral sclerosis (ALS) with bulbar onset is another diagnosis that could be considered. Initial symptoms are dysarthria and dysphagia, but the onset is subacute. The diagnosis of ALS may not be obvious early in the disease course; observation of progression of symptoms is necessary. Clinically definite ALS is diagnosed when the patient has upper motor neuron and lower motor neuron signs in at least three body segments.

Management of FCMS depends on the etiology and clinical type. In this case, treatment was focused on preventing further progression of the underlying cerebrovascular disease; the patient received anticoagulant therapy (a new oral anticoagulant), antiarrhythmic agents (digoxin, metoprolol), a statin (rosuvastatin), an angiotensin-converting enzyme inhibitor (perindopril), and antidiabetics. Because of the severe swallowing problems and in order to prevent aspiration pneumonia, a nasogastric feeding tube was placed. For communication, the patient used writing as an alternative to speech output, and he underwent speech therapy.

After 1 month of hospitalization, the patient was discharged with mildly improved status. He was able to open and close his mouth, to make some movements of the tongue in the mouth, and to articulate some monosyllabic words ("yes," "no"). At the end of the 4 weeks, he was tube-dependent, but with some oral diet of a semi-liquid consistency.


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