200 Section - Emergence of Swallowing Apraxia Following Bilateral Basal Ganglia Hemorrhage in a Post-Ischemic Stroke Patient: A Case Report

Tuesday, May 19, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

ST

Steven Cuapoco T. Tan, MD

Medical Officer III
Veterans Memorial Medical Center
Quezon City, National Capital Region, Philippines

Corresponding Author/Autor a quien dirigir la corr(s)

SO

Samuel Christian C. Ong, MD

Medical Officer III
Veterans Memorial Medical Center
Manila, National Capital Region, Philippines

Co-Author/Coautor(s)

AB

Alex Zander Bondoc, MD

Medical Specialist
Veterans Memorial Medical Center
Quezon City, National Capital Region, Philippines

Case Diagnosis: A 78-year-old Filipino male was diagnosed with mixed dysphagia due to coexisting dysarthria and swallowing apraxia following bilateral basal ganglia hemorrhage superimposed on recent left Middle Cerebral Artery (MCA) infarct. Swallowing apraxia was evidenced by impaired oral initiation and sequencing, supported by Apraxia Battery for Adults–2nd Edition (ABA-2) deficits. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) demonstrated delayed swallow initiation, residue, and reduced airway protection. Post-discharge, Modified Barium Swallow (MBS) confirmed multi-phase impairment, most severe orally, consistent with motor-planning and motor-execution deficits.

Case Description: The patient presented with right-sided weakness and dysarthria from a left MCA infarct. He was discharged on a soft diet but aspirated thin liquids (IDDSI Level 0). Seven weeks later, he developed decreased sensorium; neuroimaging revealed bilateral basal ganglia hemorrhage. Bedside findings of impaired oral initiation and disorganized lingual-labial movements suggested swallowing apraxia, supported by ABA-2 results and confirmed through FEES and MBS. He was initially discharged with NGT. Intensive outpatient therapy integrating motor-planning, sensory cueing, and strengthening enabled NGT weaning. He now maintains an IDDSI Level 4–5 diet awaiting repeat studies.

Discussions: Swallowing apraxia is an underrecognized cause of post-stroke dysphagia, particularly after bilateral subcortical injury affecting corticostriatal motor-planning circuits. Distinguishing it from dysarthria is essential as this impacts rehabilitation management. In this resource-limited setting, bedside assessment with ABA-2 enabled early identification while awaiting delayed instrumental studies. FEES and MBS confirmed mixed dysphagia, guiding combined motor-planning and execution-focused therapy. Delayed PEG consideration highlights systemic gaps and the need for standardized dysphagia pathways in the Philippines.

Conclusions: This case demonstrates swallowing apraxia after bilateral basal ganglia hemorrhage in a patient recovering from a recent infarct, resulting in complex mixed dysphagia. Early recognition through structured bedside assessment and targeted therapy supported recovery. The case underscores the need for standardized screening, timely instrumentation, and clearer enteral feeding protocols in resource-limited settings.