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Stroke

304 - An Uncommon Aneurysmal Cause of Lateral Medullary Syndrome with Severe Dysphagia Managed through Interdisciplinary Rehabilitation

Thursday, February 19, 2026
5:00 PM - 6:30 PM AST

    Presenting Author(s)

  • KS

    Kyle Smith, BS

    Medical Student
    SUNY Downstate College of Medicine
    Brooklyn, New York, United States

    • Co-Author(s)

  • MT

    MIchael Thornton, MD

    Resident Physician
    Burke Rehabilitation Hospital
    White Plains, New York, United States

  • AA

    Amru Al-Rifai, MD

    Resident Physician
    Burke Rehabilitation Hospital
    White Plains, New York, United States

  • SB

    Sharon Bushi, MD

    Attending Physician
    Burke Rehabilitation Hospital
    White Plains, New York, United States

    • Submitter(s)

  • KS

    Kyle R. Smith, BS

    SUNY Downstate College of Medicine
    Nanuet, New York, United States

Case Diagnosis: Lateral medullary syndrome (Wallenberg syndrome) secondary to left posterior inferior cerebellar artery (PICA) dissecting aneurysm rupture.

Case Description: A 46-year-old male with hypertension, hyperlipidemia, type 2 diabetes, asthma, and obesity presented with acute headache, vertigo, diplopia, and vomiting. Imaging revealed a subarachnoid hemorrhage of the basal cisterns due to a dissecting left PICA aneurysm, treated with endovascular coil embolization. Complications included severe dysphagia, left vocal cord paresis, hoarse voice, and impaired airway protection. He was admitted to acute inpatient rehabilitation with PEG dependence. On admission, he ambulated independently with a rolling walker and required only minimal assistance for lower-body ADLs, though balance and coordination deficits were noted. In contrast, swallowing impairment was profound. Initial modified barium swallow (MBS) demonstrated moderate-severe pharyngeal dysphagia, permitting only thin liquids with strict compensatory strategies and limited therapeutic puree trials hypertension, hyperlipidemia, type 2 diabetes, asthma, and obesity.

Discussions:

While ischemic infarction is the classic etiology of lateral medullary syndrome, aneurysmal rupture is rare. Dysphagia is a hallmark manifestation, reflecting nucleus ambiguus involvement, and represents a major barrier to safe oral intake. Rehabilitation emphasized intensive speech-language pathology intervention including compensatory strategies, chin tuck against resistance, Mendelsohn maneuver, effortful swallow, and neuromuscular re-education with therapeutic PO trials. Over the course of admission, repeat MBS showed progressive improvement in swallow efficiency and safety, with advancement from PEG-only to NDD2 mechanically altered solids and thin liquids. Physical and occupational therapy addressed mild balance and coordination deficits, and the patient ultimately achieved independence with mobility and ADLs.

Conclusions:

This case illustrates an uncommon aneurysmal cause of lateral medullary syndrome with severe, persistent dysphagia. Intensive interdisciplinary rehabilitation, particularly targeted swallowing therapy, enabled safe diet advancement and PEG removal within one week of discharge. Physiatrists play a critical role in coordinating management of complex brainstem pathology to optimize recovery and functional reintegration.