A 71-year-old man with a history of coronary artery bypass graft (CABG), left carotid endarterectomy (CEA), abdominal aortic aneurysm (AAA) repair, bilateral femoral artery bypass, hypertension, and cigarette smoking was evaluated because of a 9-month history of slurred speech, swallowing difficulties, and tongue weakness. He also had headaches and posterior neck pain. Once, he had a “passing out” spell. Since that event, he had balance difficulties.

Swallowing is a complex process that involves efferent and afferent fibers from the nuclei of cranial nerves (CN) V, VII, IX, X, and XII. Disorders of swallowing and articulation can be acute, subacute, chronic, persistent, or episodic and can be caused by a variety of central nervous system and neuromuscular disorders. Our patient had multiple vascular risk factors. He consulted because of subacute progressive and persistent swallowing and speech difficulties,
imbalance, and posterior neck pain. Other symptoms of possible vertebrobasilar ischemia such as vertigo, diplopia, or visual field defects were lacking. Although our patient had a “passing out” spell, it was not characteristic of syncope due to glossopharyngeal or vagal dysfunction. The most worrisome concern was his oropharyngeal dysphagia. He had no evidence of hoarseness. His dysphagia resulted in considerable weight loss.