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Malnutrition associated with Wallenberg Syndrome: Case report

Introduction: Wallenberg Syndrome (SW) is characterized by the condition of swallowing impairment, and nutritional assessment is essential to prevent weight loss. Objective: To report a case of malnutrition associated with SW. Methods: Report of malnutrition in a patient diagnosed with SW in a public hospital in Santa Catarina-Brazil. Results: Elderly, 67 years old, male, retiring, systemic arterial hypertension story and ischemic stroke (without sequelae). He sought assistance on 03/17/2020 in a public hospital in Joinville/SC reporting dysphagia and vertigo, being admitted for investigation of a new vascular event. During hospitalization, he presented: constipation, vertigo, hoarseness, odynophagia, hiccups, regurgitation, emesis, heartburn and drooling. He underwent cranial magnetic resonance imaging confirming infarction in a left posterior-lateral bulb, with a vertebral lesion in the V4 portion, characterizing the SW. He underwent a videodeglutogram, showing a risk of silent bronchoaspiration and with prolonged rehabilitation time, making it necessary to choose an alternative feeding route, initially a nasoenteral tube. Initial anthropometric assessment (03/17/2020): BMI 27.47 kg/m² (height: 163 cm, weight: 73 kg). During hospitalization there was a reduction of -7.9 kg (final weight 65.1 kg; BMI 24.3 kg/m², totaling 10.82% loss (04/23/2020) in 1 month (considered severe). Brachial circumference decreased from 31 (03/24) to 28 cm (04/10). On physical examination: distended abdomen, loss of muscle mass at the temples and subcutaneous fat (biceps). This abrupt nutritional loss was associated with low diet tolerance gastrointestinal night infusion and volumes above 85 ml/h, making it impossible to reach a nutritional goal, he was discharged with gastrostomy, continued to undergo rehabilitation with a speech therapist at home and after 3 months he returned to exclusive oral feeding. Conclusion: Patients diagnosed with SW should be monitored about diet tolerance and to avoid risk of complications associated with weight loss and risk of bronchoaspiration.