Bulbar Palsy as a Presentation of Medullary Ischemic Stroke: An Educational Case Report

Aims: Medullary ischemic strokes are uncommon and often present with complex neurological symptoms. The clinical characteristics of bulbar palsy, which can be a common presentation for other diseases, add to the difficulties in diagnosing and treating such cases. The primary aim of documenting this case is to highlight the diagnostic and management challenges of this complex presentation. Presentation of Case: We report a case of a 45-year-old male with a personal history of long-term smoking and alcoholism, who experienced tongue deviation, difficulty swallowing, dystonia, and epigastric pain. Magnetic resonance imaging confirmed an acute medullary infarct without hemiparesis. The patient was managed with non-pharmacological and pharmacological therapy. The patient’s improvement in outcome was assessed with the use of the National institute of health stroke scale score. He also showed gradual improvement in symptoms throughout admission. Discussion: The patient presentation mimicked bulbar palsy but imaging and cranial nerve examinations helped in accurate diagnosis and treatment. Conclusion: This case highlights the importance of early neuroimaging in atypical neurological presentation and also underscores the need for thorough cranial nerve assessment.