Chronic Dysphagia, Vomiting and Gastroesophageal Reflux as Manifestations of a Brain Stem Glioma: A Case Report

Frank, Yitzchak; Sb, Schwartz; Ne, Epstein; Hr, Beresford

doi:10.1159/000120480

Cited by 17 publications

(7 citation statements)

References 10 publications

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“…Several case studies have reported dysphagia as a primary or secondary complaint in patients with [6][7][8]. Mukand et al [9] conducted a study investigating the common neurologic problems in adults with brain tumors admitted for inpatient rehabilitation.…”

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confidence: 99%

Dysphagia Outcomes in Patients with Brain Tumors Undergoing Inpatient Rehabilitation

et al. 2003

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The purpose of this retrospective study was to compare functional dysphagia outcomes following inpatient rehabilitation for patients with brain tumors with that of patients following a stroke. Group 1 (n = 24) consisted of consecutive admissions to the brain injury program with the diagnosis of brain tumor and dysphagia. Group 2 (n = 24) consisted of matched, consecutive admissions, with the diagnosis of acute stroke and dysphagia. Group 2 was matched for age, site of lesion, and initial composite cognitive FIM score. The main outcome measures for this study included the American Speech-Language-Hearing Association (ASHA) National Outcome Measurement System (NOMS) swallowing scale, length of stay, hospital charges, and medical complications. Results showed that swallowing gains made by both groups as evaluated by the admission and discharge ASHA NOMS levels were considered to be statistically significant. The differences for length of stay, total hospital charges, and speech charges between the two groups were not considered to be statistically significant. Three patients in the brain tumor group (12.5%) demonstrated dysphagia complications of either dehydration or pneumonia during their treatment course as compared to 0% in the stroke group. This study confirms that functional dysphagia gains can be achieved for patients with brain tumors undergoing inpatient rehabilitation and that they should be afforded the same type and intensity of rehabilitation for their swallowing that is provided to patients following a stroke.

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confidence: 99%

Dysphagia Outcomes in Patients with Brain Tumors Undergoing Inpatient Rehabilitation

et al. 2003

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“…We tentatively diagnosed this patient with atypical Möbius syndrome ( Table 1), based on these considerations. The association of GERD and brainstem dysfunction in the present patients may be reminiscent of some cases with brainstem glioma [8,15,32], where GER was the initial manifestation of the dysfunction of the medulla oblongata.…”

Section: Discussionmentioning

confidence: 59%

“…Thus, the dysfunction of vago-vagal reflex through the medullary tegmentum can be regarded as an important factor, if not the sole factor, of dysphagia and GERD. These complications can be the initial or predominating symptom of brainstem lesions in patients with glioma [8,15,23] or Chiari malformations [23], similar to patient 4. We propose the term "dysphagia-GER complex" to describe the disturbed motility of the upper digestive tract due to brainstem dysfunction, particularly involving the NTSmediated reflex pathways.…”

Section: Discussionmentioning

confidence: 80%

Dysphagia-Gastroesophageal Reflux Complex: Complications Due to Dysfunction of Solitary Tract Nucleus-Mediated Vago-Vagal Reflex

et al. 2006

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We report on the complication of gastroesophageal reflux (GER) in four patients with lower brainstem dysfunction. These patients suffered from perinatal asphyxia, cerebellar hemorrhage, or congenital dysphagia of unknown origin and showed facial nerve palsy, inspiratory stridor due to vocal cord paralysis, central sleep apnea, and dysphagia, in various combinations. Naso-intestinal tube feeding was introduced in all of the patients due to recurrent vomiting and aspiration pneumonia resulting from GER. T2-weighted magnetic resonance (MR) imaging revealed symmetrical high intensity lesions in the tegmentum of the lower pons and the medulla oblongata in two of the patients, and pontomedullary atrophy in another patient. In normal subjects, lower esophageal sphincter contraction is provoked by distension of the gastric wall, through a vago-vagal reflex. Since this reflex arc involves the solitary tract nucleus, where the swallowing center is located, the association of dysphagia and GER in the present patients is thought to result from the lesions in the tegmentum of medulla oblongata. We propose the term "dysphagia-GER complex" to describe the disturbed motility of the upper digestive tract due to lower brainstem involvement. In children with brainstem lesions, neurological assessment of GER is warranted, in addition to the examination of other signs of brainstem dysfunction, including dysphagia and respiratory disturbance.

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“…For this reason, unless specifically mentioned, cases published before 1950 are omitted in this discussion, as is 1 associated with osteopenia.24 More recent reports of weight loss associated with these tumors indicate that weight loss can be severe early in the disease. [1][2][3][4][5][6]9,10,[12][13][14][15][16]19 The second case of Burr et a12 is included even though tumor probably extended around the third ventricle because there was good weight and height gain after excision of the brain stem tumor.…”

Section: Discussionmentioning

confidence: 99%

Weight and Height Deficits in Children with Brain Stem Tumors

Lehman

Krishnamurthy

Berlin

2002

Clin Pediatr (Phila)

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Weight deficit is common among children with brain stem tumors and is often accompanied by height deficit. Among 22 consecutive children (< or =18 years) with brain stem tumor, 16 had weight deficit (< or =20th percentile) (p<1.4e-7). Eleven were at or less than the 5th percentile, and 5 were less than the 1st weight percentile. Eight also had height deficit (< or =20th percentile) (p<0.06). Misdiagnoses occurred: failure to thrive in 5, growth retardation in 2, and anorexia nervosa in 2. Delay between these diagnoses and that of brain tumor averaged 4.5 years. Detailed neuroradiologic study seems worthwhile if weight deficit is extreme and either unexplained or uncorrectable, or if the weight deficit is accompanied by an abnormality suggestive of intracranial disease.

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Chronic Dysphagia, Vomiting and Gastroesophageal Reflux as Manifestations of a Brain Stem Glioma: A Case Report

Cited by 17 publications

References 10 publications

Dysphagia Outcomes in Patients with Brain Tumors Undergoing Inpatient Rehabilitation

Dysphagia Outcomes in Patients with Brain Tumors Undergoing Inpatient Rehabilitation

Dysphagia-Gastroesophageal Reflux Complex: Complications Due to Dysfunction of Solitary Tract Nucleus-Mediated Vago-Vagal Reflex

Weight and Height Deficits in Children with Brain Stem Tumors

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