1407 - From Stroke to Swelling: Acute Parotiditis as an Overlooked Neurologic Sequela

An 81-year-old female with history of hypertension, left parotiditis (2016) initially presented with symptoms of slurred speech, unsteady gait and right facial droop. MRI was significant for acute left paramedian pontine infarct. Upon arrival to AIR, physical exam was significant for right facial droop, dysarthria, right dysmetria, dry mucous membranes, and maxillary dentures. Diet was puree with honey thick liquids by teaspoon. A few days after admission the patient developed right sided jaw pain, erythema, and edema with leukocytosis. CT demonstrated acute acalculous right parotiditis. Augmentin was started, WBCs and symptoms improved. ENT further recommended hydration and gentle massaging to parotid.


Discussions:

The acalculous nature of the parotiditis raised curiosity regarding a possible etiology. There is a paucity of literature exploring the association between parotiditis and stroke. Pontine strokes commonly lead to dysphagia due to disruption of the corticobulbar tract. Post-stroke weakness of the muscles of mastication on the affected side diminish the masticatory-parotid reflex and can reduce salivary output. The presence of dentures in stroke patients has also been associated with decreased basal salivary secretion. Resulting salivary stasis likely played a role in acute parotiditis. P.O fluid intake via teaspoon likely exacerbated the pathology through dehydration. Lastly, her remote history of left parotiditis (2016) may indicate an underlying baseline abnormality which contributed to the current presentation.


Conclusions:

The differential diagnosis for acute jaw swelling and pain in a stroke patient should include parotiditis, especially when risk factors such as pontine stroke and poor hydration status are present. Early preventative steps should be taken in such patients including ensuring adequate hydration and optimizing medication lists. Caution should be taken when administering medications which may have anticholinergic or dehydrating effects. Early recognition and treatment are critical to prevent further complications including abscess formation.