Post stroke progressive dysphagia and dysarthria

75 y.o. female with h/o two strokes in last one year now has progressive dysphagia even for liquids as well as dysarthria. She had mild weakness in her left arm which has improved. CT head showed Encephalomalacia and gliosis in Right Parietal lobe s/o chronic Right MCA infarct with old lacunar infarct in Left Basal Ganglia. Echo showed normal study with no thrombi or septal defect and normal LV function. Carotids were normal too. BP at presentation was 164/100. At present 130/80. Rigid laryngoscopic exam showed normal results. ECG was normal. KFTs LFTs Lipid profile and Bld Sugar were normal Patient has been taking Tab Amlopres 5 (1 OD) Cap Ecosprin AV 20/75 (1 OD) Tab Afogatran 75 (1 BD) Tab Neurobion forte (1 OD) Syp Normabrain (1 tsf BD) She has been following this treatment for almost 5 months now and her dysphagia and dysarthria has progressed to a great extent. She is losing weight as a result and hope too. Kindly advise what can be done to improve her post stroke dysphagia and dysarthria as it has become a matter of life and death for this poor patient. Your guidance will be highly appreciated. Thank you Take care.

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Hello @@A I. Having read your message, I have a few questions. 1. Was there a time gap between the 2 strokes reported in her MRI? 2. Was there a time gap between the stroke and the bulbar symptoms becoming progressive? 3. Are the symptoms progressive or are the results of stroke induced bulbar symptoms progressive? I would suggest starting RT and parenteral feeds. Plan a PEG. Bulbar and Swallowing exercises should be focused upon such as the double swallowing technique. I also would recommend a detailed history and reevaluation of the bulbar symptoms by a neurologist and an ENT specialist to rule any other cause of progressive bulbar symptoms before labeling them post stroke. Watch out for possible seizures. If possible please let us know the answers to the 3 Qs. Wishing you and the patient good health. Dr Saumya Mittal

Thank you Sir, Grateful that you took the time out to give your valuable advice. Will try to get in touch when I have more info abt the pt. Take care.
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Facial exercise speech therapy breathing exercise spirometry

Thank you doctor
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Is she on PEG feeds ?

Hi, No, until now she used to take liquid diet orally.
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