Journal of the Louisiana State Medical Society

Case: A 55-year-old woman with a history of seizures and submandibular stones, presented with dysphagia. Five days prior to presentation, she woke up with urine in her bed, headache, and confusion consistent with prior nocturnal seizures; however that morning she had difficulty swallowing solids, accompanied by nausea and vomiting. Over the next few days, her symptoms worsened to include mild dysphagia to liquids, shortness of breath, and voice changes. On physical exam, she was hypertensive at 164/97 with oxygen saturation at 97% on room air. She had submandibular fullness bilaterally with a clear oropharynx. No focal neurologic deficits were appreciated. Flexible fiber optic laryngoscopy found the posterior pharyngeal wall significantly pushed anteriorly. Modified barium swallow demonstrated a narrow pharynx due to mass versus swelling of tissue on posterior pharyngeal wall at C3-C4, leading to decreased laryngeal elevation and poor epiglottic inversion. CT neck with IV contrast demonstrated exuberant osteophytes with preserved intervertebral disk height located at C3, C4, C5, C6, and C7 with C3-C4 osteophytes displacing the prevertebral soft tissues anteriorly at the level of the epiglottis, consistent with symptomatic Forestier’s syndrome. A PEG tube was placed for nutrition requirements and neurosurgery recommended outpatient surgical decompression.