Diabetic vagal mononeuropathy manifesting with isolated dysphagia

Vagal mononeuropathy is very rare. Diabetes mellitus is one of the causes of this rare disease condition. Here we report a 44-year-old woman who presented with an idiopathic vagal mononeuropathy and was finally diagnosed with diabetic vagal mononeuropathy. She presented with isolated dysphagia without hoarseness or other symptoms related with vagal dysfunction. Except for diabetes mellitus, no abnormalities were found by routine and specific checkups including brain imaging, gastroscopy, electromyography, and laryngoscopy. Finally, 12 days later, she abruptly developed hoarseness without other cranial nerve dysfunction.We suggest that her neurological symptoms originated from diabetes affecting the vagus nerve in isolation. Clinicians should pay attention to this association, especially when they encounter a patient with diabetes mellitus with sudden idiopathic dysphagia even without problems of vocalization. Neurology Asia 2015; 20(2) : 187 – 189 Address correspondence to: Jong Seok Bae, MD PhD, Department of Neurology, Kangdong Sacred Heart Hospital, 150, Seongan-ro, Gangdong-gu, Seoul 134-701, Korea. Tel: +82-2-2224-2854, Fax: +82-2-2224-2339, E-mail: [email protected] INTRODUCTION Vagal mononeuropathy is very rare and usually combined with other cranial neuropathies such as glossopharyngeal or accessory neuropathy. Thus, purely isolated vagal mononeuropathy has been rarely reported. In addition, the majority of vagal mononeuropathy co-presents with changesof the voice (i.e. hoarseness). Although most vagal mononeuropathy is idiopathic, diabetes mellitus (DM) and viral infection are considered possible etiologies. Recently, we saw a patient with an isolated vagal mononeuropathy, initially presenting only with dysphagia. The patient had no voice problem during the initial 11 days of disease course. Therefore, we suspected other etiologies of the swallowing problem such as from neuromuscular or esophageal origins. After the patient additionally developed hoarseness and was diagnosed with overt DM, we diagnosed diabetic vagal mononeuropathy.