# Role of Acute Physiotherapy in Bilateral Medial Medullary Infarction: A Case Report

## TL;DR

This case report describes the use of acute physiotherapy in a rare stroke condition called bilateral medial medullary infarction to improve respiratory outcomes.

## Contribution

The report highlights the importance of early physiotherapy in managing severe respiratory complications in a rare stroke syndrome.

## Key findings

- Physiotherapy in the acute phase helped prevent severe aspiration pneumonia and respiratory failure.
- Mechanical insufflation-exsufflation and postural drainage improved airway clearance in the patient.
- The patient transitioned to recovery phase rehabilitation after 60 days of treatment.

## Abstract

Bilateral medial medullary infarction (BMMI) is a rare stroke syndrome, which frequently has poor clinical outcomes. Reports on physical therapy for BMMI are few because of its poor prognosis. Therefore, this report aims to present a patient who developed BMMI and underwent well-considered rehabilitation. A 67-year-old man presented to our clinic with an acute onset of vomiting and dizziness. Magnetic resonance imaging (MRI) showed no abnormal signal intensity, and the patient was admitted for peripheral dizziness. On day two, he developed quadriplegia, bulbar palsy, and respiratory impairment, such as prolonged apnea. A second MRI revealed a high-intensity lesion in the bilateral medial medulla oblongata. He was diagnosed with BMMI, and rehabilitation treatment was initiated. On day 16, his sputum volume increased, and he could not expectorate effectively due to decreased coughing ability. Therefore, mechanical insufflation-exsufflation (MI-E) was performed to improve his airway clearance. On day 21, he developed aspiration pneumonia (AP), which became severe and led to acute respiratory failure. Nasal airway intubation and oxygen flow of 5 L/minute were initiated. His respiratory function was not seriously aggravated, and recurrent AP was prevented with the application of respiratory physiotherapy procedures, such as postural drainage, in collaboration with other medical staff, and MI-E. On day 60, the patient was transferred to the recovery phase rehabilitation ward. BMMI tends to worsen swallowing disorders progressively and is associated with a high risk of severe AP. Providing physiotherapy in the acute phase is important to reduce the risk of serious illness.