An Unusual Cause of Impaired Speech and Swallowing

An 82-year-old female patient exhibited muffled speech after being transferred to our department following bowel surgery. The patient herself complained only of a 4-month history of neck pain, with no dysphagia. However, on the basis of patient history supplied by a third party, it was possible to determine a temporal link between the painfully restricted movement in the cervical spine and impaired speech. Laboratory tests revealed elevated inflammatory parameters (leukocytes 15 Gpt/L, CrP 119 mg/L). A clinical swallowing test indicated pathological deglutition without effective clearing. Fiberoptic endoscopic evaluation swallowing (FEES) demonstrated an unexplained mass in the pharynx. Computed tomography showed an extensive prevertebral abscess and destruction of the atlantoaxial joint. Surgical treatment of this lesion, which is rarely seen in this form, was performed by means of transoral abscess drainage and dorsal spondylodesis of C0–C2. Staphylococcus aureus and Enterococcus faecalis were detected intraoperatively. No further focus of infection was found. Antibiotic treatment was administered for 12 weeks. The postoperative course was normal and speech and swallowing normalized.

Translated from the original German by Christine Rye.

Cite this as: Glück G, Heyne JP, Gockel H: An unusual cause of impaired speech and swallowing.

Figure.

Sagittal multiplanar reconstruction of the contrast-enhanced cervical CT.

A centrally hypodense, ring-enhancing prevertebral mass measuring 46 × 41 × 69 mm consistent with an abscess and involvement of the atlantoaxial joint and intraspinal component (upper arrow).