Efficacy of postural techniques assessed by videofluoroscopy for myasthenia gravis with dysphagia as the presenting symptom: a case report

Abstract

Introduction: Oropharyngeal weakness leading to dysphagia is rarely the presenting symptom of myasthenia gravis, but it can be a significant source of morbidity and mortality. The earliest possible diagnosis of myasthenia gravis should be made for better management of this cause of treatable dysphagia. A detailed evaluation of swallowing by videofluoroscopy can assist in making an accurate diagnosis and in individualizing appropriate diet compensatory techniques.

Case presentation: We present the case of a 57-year-old Taiwanese man with dysphagia as the presenting symptom of myasthenia gravis, and evaluate the pathological findings of swallowing and effectiveness of compensatory postural techniques for dysphagia using videofluoroscopy.

Conclusions: Videofluoroscopy is a valuable technique for evaluating myasthenia gravis dysphagia, because it allows swallowing interventions to be precisely individualized in accordance with the results obtained.

Figure 1

Videofluoroscopic image, anteroposterior projection, first swallow with pudding. The image shows small volume residues in the valleculae and the pyriform sinuses (bilateral pyriform sinuses indicated with white arrows).

Figure 2

Videofluoroscopic image, anteroposterior projection, after five swallows with pudding. Residues were increased in volume, particularly in the left pyriform sinuses (indicated with white arrow), compared with Figure 1.

Figure 3

Videofluoroscopic image, anteroposterior projection, with the head rotated to the left side. Residues decreased in volume and no aspiration was detected.