Objective: To describe an atypical presentation of Idiopathic Parkinson’s disease.

Background: Dysphagia is a commonly reported “non-motor” feature of Idiopathic Parkinson’s disease (IPD), which usually occurs in advanced PD and is Levodopa unresponsive[1].

Methods: Case Presentation: A 58 year-old man was seen by the ENT service with a 15 year history of mild dysphagia and 2.5 years history of severe dysphagia to solids, but not fluids, which caused significant weight loss. He switched from regular to pureed diet. No other neurological features were seen initially, however left arm rest tremor was noted 6 months after the onset of severe dysphagia. At age 59, a Consultant Neurologist diagnosed IPD. Rasagiline did not improve the dysphagia nor his other symptoms. His swallow improved markedly following the introduction of Levodopa/Carbidopa and the patient recommenced normal diet. At age 60, he was hypomimic, had reduced left arm swing and stooped posture on gait examination; left arm rest tremor and bradykinesia were noted. The cranial nerve examination and the remaining limb examination were normal. He had no ptosis, diplopia, muscle wasting, fasciculations or weakness.

Results: Investigations: Videofluoroscopy prior to IPD diagnosis: Moderate pharyngeal dysphagia, with silent aspiration; Barium swallow at age 59: No oesophageal dysmotility, aspiration of contrast into trachea noted; Pan-endoscopy at age 59: normal examination, noted oesophageal dysmotility. MR brain: Non-specific white matter changes.

Conclusions: We report a patient with a 15 year history of mild dysphagia, followed by subacute onset severe dysphagia, which improved remarkably on Levodopa. Dysphagia is a rare presentation of IPD and this case expands the differential diagnosis of neurological causes for dysphagia.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/idiopathic-parkinsons-disease-presenting-with-dysphagia-15-years-before-pd-diagnosis/