London, United Kingdom 2013 E-Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 603 20 Interesting and challenging cases Withdrawn! 19 Interesting and challenging cases Transient aphagia: vertebrobasilar TIA in a patient with a previous left hemispheric TACI or teeth at the wrong end of the GI tract? D. Bereczki1, G. Tamás2, A. Lindner3, K. Müllner4, A. Takáts5 Department of Neurology, Semmelweis University, Budapest, HUNGARY1, Department of Neu-rology, Semmelweis University, Budapest, HUNGARY2, Department of Neurology, Semmelweis University, Budapest, HUNGARY3, 2nd Department of Internal Medicine, Semmelweis University, Budapest, HUNGARY4, Department of Neurology, Semmelweis University, Budapest, HUNGARY5 Background: About every 4th stroke is a recurrent one. Therefore, if an acute neurological sign ap-pears in a patient with a previous stroke, he is often admitted to a stroke unit. Case summary: an 83 year-old patient with a left hemispheric total anterior circulation (TACI) stroke 8 years before was admitted to our stroke unit with an acute onset severe dysphagia. He sur-vived his previous stroke with severe residual signs and was taken care at his home by his daughter. He was able to sit alone in an armchair and feed himself with the non-paretic upper extremity. On admission the totally aphasic old man was alert, had spastic right sided hemiplegia, hemianopia, ex-aggerated reflexes on the right side and liberation signs. He had severe dysphagia – practically apha-gia. CT revealed the old large infarct in the left hemisphere, but no acute lesion was seen. The in-troduction of a nasogastric tube was troublesome but finally successful. By the next day the aphagia completely resolved. A thoraco-abdominal X-ray found a metal containing alien body resembling teeth in the abdominal region. Colonoscopy identified a denture in the sigmoid intestine – congru-ent with the information about a recently lost denture of the daughter of the patient. Most probably, when the old man was left alone shortly during dinner time, his liberation signs (grasping and suck-ing reflex) helped him to grab and swallow the denture of her daughter left unattended on the table. This alien body stuck in the esophagus resulting in aphagia. The introduction of the nasogastric tube moved the denture further in the gastrointestinal tract, resolving the aphagia. Conclusion: acute onset dysphagia in a patient with severe long lasting cerebrovascular disease may be other than a recurrent vertebrobasilar stroke or supranuclear palsy. Resolving the signs also does not prove the event was a TIA. Searching for an intrathoracic space occupying disease or for an alien body may give the clue in rare cases.
Karger_ESC London_2013
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