Question

Case 4 Presentation: A 15-year old male patient was admitted to the ER because an inability to swallow his breakfast. He had been discharged from the hospital 36-hours prior following two weeks of recovery from a motor vehicle accident that resulted in a compound tib-fib fracture, as well as other broken bones. Neurological E*am: Touch discrimination of the left forehead is impaired and mild temperature sensation in the right hand is absent. Gag reflex is not present upon tactile stimulation of the soft palate. No other motor, sensory, or behavioral findings were present in the neurological e*am. History: The patient had been previously diagnosed (at 12 years of age) with an atrial septal defect (ASD) of the heart. No family history is of consequence to this case.

What is the most likely cause of these deficits considering that they presented two weeks after the original accident, are limited in scope, and improved with therapy?

how does the patient’s history suggest a cause for this episode (especially considering his age)?

Answer 1

The patient might be having Dysphagia lusoria .Dysphagia lusoria is an abnormal condition with difficulty in swallowing caused by an aberrant right subclavian artery.

During development of aortic arch, if the proximal portion of the right fourth arch disappears instead of distal portion and the right subclavian artery will arise as the last branch of aortic arch and then it courses behind the esophagus to supply blood to right arm. This causes pressure on esophagus and results in dysphagia.

Patients with this anomaly are usually asymptomatic and even though this condition is a congenital anomaly, patients usually do not present with it in childhood and they only become symptomatic in young adulthood and even in middle or old age.

Here, since the patient haf not treated his anomaly, he became symptomatic in his early adulthood.

Hope this helps you.thank you?