ABSTRACT
A Pancoast tumor is a rare form of lung cancer that occurs mainly in the apex of the lung as the main symptom of upper extremity pain. Oropharyngeal dysphagia is not a common symptom. This case report describes a 57-year-old male patient with a Pancoast tumor who presented with oropharyngeal dysphagia. The patient's symptoms included left shoulder and arm pain. The chest computed tomography revealed a mass in the apex of the left lung, invading the mediastinum and compressing the left brachial vein and brachial plexus. He was discharged after receiving palliative chemotherapy. The patient returned to the hospital with dyspnea and was diagnosed with aspiration pneumonia. The cranial nerve exam confirmed hoarseness and an absent gag reflex. In addition, the laryngeal elevation decreased, and the bedside water test was positive. A video fluoroscopic swallow study confirmed the presence of oropharyngeal dysphagia, which was attributed to left glossopharyngeal and vagus nerve damage associated with the Pancoast tumor. This case highlights the need to be aware that a Pancoast tumor can cause oropharyngeal dysphagia. If oropharyngeal dysphagia is suspected, VFSS should be performed to prevent complications leading to mortality from lung cancer.
ABSTRACT
Objective@#To analyze the epidemiological information of patients with traumatic spinal cord injury (SCI) and concomitant traumatic brain injury (TBI) and to suggest points to be aware of during the initial physical examination of patients with SCI. @*Methods@#This study was a retrospective, observational study conducted in a regional trauma center. All the records of patients diagnosed with traumatic SCI between 2016 and 2020 were reviewed. A total of 627 patients with confirmed traumatic SCI were hospitalized. A retrospective study was conducted on 363 individuals. @*Results@#The epidemiological data of 363 individuals were investigated. Changes in American Spinal Injury Association Impairment Scale (AIS) scores in patients with SCI were evaluated. The initial evaluation was performed on average 11 days after the injury, and a follow-up examination was performed 43 days after. Fourteen of the 24 patients identified as having AIS A and SCI with concomitant TBI in the initial evaluation showed neurologic level of injury (NLI) recovery with AIS B or more. The conversion rate in patients with SCI and concomitant TBI exceeded that reported in previous studies in individuals with SCI. @*Conclusions@#Physical, cognitive, and emotional impairments caused by TBI present significant challenges in rehabilitating patients with SCI. In this study, the influence of concomitant TBI lesions could have caused the initial AIS assessment to be incorrect.
ABSTRACT
Objective@#To utilize pulmonary function parameters as predictive factors for dysphagia in individuals with cervical spinal cord injuries (CSCIs). @*Methods@#Medical records of 78 individuals with CSCIs were retrospectively reviewed. The pulmonary function was evaluated using spirometry and peak flow meter, whereas the swallowing function was assessed using a videofluoroscopic swallowing study. Participants were divided into the non-penetration-aspiration group (score 1 on the Penetration-Aspiration Scale [PAS]) and penetration-aspiration group (scores 2–8 on the PAS). Individuals with pharyngeal residue grade scores >1 were included in the pharyngeal residue group. @*Results@#The mean age was significantly higher in the penetration-aspiration and pharyngeal residue groups. In this study, individuals with clinical features, such as advanced age, history of tracheostomy, anterior surgical approach, and higher neurological level of injury, had significantly more penetration-aspiration or pharyngeal residue. Individuals in the penetration-aspiration group had significantly lower peak cough flow (PCF) levels. Individuals in the pharyngeal residue group had a significantly lower forced expiratory volume in 1 second (FEV1). According to the receiver operating characteristic curve analysis of PCF and FEV1 on the PAS, the cutoff value was 140 L/min and 37.5% of the predicted value, respectively. @*Conclusion@#Low PCF and FEV1 values may predict the risk of dysphagia in individuals with CSCIs. In these individuals, active evaluation of swallowing is recommended to confirm dysphagia.
ABSTRACT
Diaphragm dysfunction can originate from various etiologies, and bilaterality of the dysfunction depends on the cause. Symptoms of diaphragm dysfunction vary depending on the degree of phrenic nerve denervation, spinal cord lesion, and involvement of the diaphragm. Several infectious diaphragmatic dysfunctions have been reported, including the human immunodeficiency virus, poliovirus, West Nile virus, and dengue virus. Here, we report a case of unilateral diaphragm paralysis in a 34-year-old man with neurosyphilis.