# Oromandibular Dystonia and Dysphagia in Hyperglycemic Brainstem Dysfunction

## TL;DR

A man with uncontrolled diabetes developed jaw dystonia and swallowing issues due to brainstem dysfunction from high blood sugar, which improved with treatment.

## Contribution

This case highlights oromandibular dystonia and dysphagia as rare non-choreiform symptoms of hyperglycemia-induced brainstem dysfunction.

## Key findings

- MRI showed reversible T2 hyperintensities in the pons without striatal involvement.
- Symptoms resolved with insulin therapy and tetrabenazine.
- FEES helped detect subtle swallowing complications.

## Abstract

Hyperglycemia-induced movement disorders usually present as hemichorea or hemiballismus. Non-choreiform presentations are rare and often overlooked.

We present the case of a 36-year-old man with uncontrolled type 2 diabetes who developed painful oromandibular dystonia, dysarthria and dysphagia. These symptoms were investigated using flexible endoscopic evaluation of swallowing (FEES). An MRI revealed reversible T2 hyperintensities in the pons without striatal involvement. The symptoms resolved with insulin normalization and tetrabenazine treatment.

Transient brainstem dysfunction due to hyperglycemia may present with oromandibular dystonia and dysphagia. FEES facilitates early detection of subtle yet clinically relevant complications.