Progressive dysphagia without dysarthria

A 50-year-old woman was referred with a 6-month history of progressive dysphagia. On examination, there was no dysarthria. Her voice was initially ‘wet’ but improved with coughing and throat clearing. Palatal movement, pharyngeal sensation and tongue appearance were normal. Laryngoscopy was normal. MRI of the brain showed a type 1 Chiari malformation with brainstem compression (figure 1). Following …