Left-sided Weakness Research Articles

Intracerebral hemorrhage in Sturge Weber Syndrome: A case report

Background. Encephalotrigeminal angiomatosis also called Sturge Weber Syndrome (SWS) is neurocutaneous abnormality with angioma affecting the leptomeninges and the face skin, commonly in the eyes and maxillary distribution of trigeminal nerve. The characteristic of SWS is dilated face skin veins, and referred to nevus flammeus and port wine stain. Case reports. We report a case of Sturge Weber Syndrome in a 41 years old male with uncontrolled hypertension and smoking, left-sided weakness, and left-sided facial port wine stain. Conclusions. Neurological examination was suggestive of SWS and further radiological examination confirmed the diagnosis.

Clinical Reasoning: Hyperventilation-Induced Alternating Hemiplegia With Concomitant Hemispheric EEG Slowing in a 7-Year-Old Girl With Headache.

A 7-year-old right-handed girl presented to the pediatric neurology outpatient clinic after 5 episodes of headache over the previous 3 months. Her family history was positive for migraine in the mother and maternal grandmother and for febrile seizures in the older sister. The neurologic examination and cognitive profile were normal. Five seconds after the end of hyperventilation, video-EEG showed high-amplitude delta waves predominantly over the left hemisphere with concomitant acute aphasia and right-sided weakness. After the event, which self-resolved over 8 minutes, the girl showed intact recall. A second instance of hyperventilation evoked the appearance of pseudo-rhythmic slow activity localized to the right hemisphere, associated with left-sided weakness, 20 seconds after the end of the test. This event spontaneously resolved in 3 minutes and was followed by headache.An exaggerated physiologic response to hyperventilation, the possible epileptic nature of the events, and a migraine variant were all considered in the differential. Nonetheless, the EEG slowing is shorter in duration and generalized in physiologic and paraphysiological conditions. A clear ictal morphology and evolution of the EEG activity were lacking in this case, and migraine attacks induced by hyperpnea have not been reported to date. Instead, EEG alterations similar to that observed in our patient are described in association with vascular abnormalities. We report the clinical presentation and diagnostic workup of a rare cerebrovascular disorder, highlighting the key features in the differential. Our case emphasizes the clinical value of the EEG rebuild-up phenomenon, which can help the clinician in achieving a prompt diagnosis.

An Unusual Case of Contralateral Hypoglossal and Recurrent Laryngeal Nerve Palsies Following Endotracheal Intubation.

We present an unusual case of a 62-year-old male presenting with contralateral hypoglossal and recurrent laryngeal nerve palsies following endotracheal intubation for emergency cardiac surgery. Postoperative, the patient was referred to Speech and Language Therapy due to concerns regarding the safety of his swallow. Oromotor assessment revealed left-sided tongue weakness and aphonia. Flexible endoscopic evaluation of swallowing (FEES) revealed a right vocal cord palsy and severe oropharyngeal dysphagia. There were no other focal neurological signs. An MRI head did not demonstrate a medial medullary stroke or other intracranial lesion. CT neck showed no abnormality identified in relation to the course of the right vagus nerve or recurrent laryngeal nerve at the skull base or through the neck respectively. The patient required a gastrostomy for nutrition and hydration. He continued to be assessed at several month intervals over the course of a year using FEES to obtain a range of voice, secretion and swallowing outcome measures. The patient commenced intensive dysphagia therapy targeting pharyngeal drive, hyolaryngeal excursion and laryngeal sensation. Swallow manoeuvres were trialled during FEES and a head-turn to the side of the vocal cord palsy during deglutition reduced aspiration risk which expedited return to oral intake. The patient had partial recovery over twelve months. Hypoglossal nerve palsy completely resolved. The right vocal cord remained paralysed however the left vocal cord compensated enabling the patient to produce a normal voice. The patient was able to take thin fluids and regular diet and the gastrostomy was removed.

Scrub typhus with hemorrhagic stroke: a case report

BackgroundScrub typhus, caused by Orientia tsutsugamushi, rarely leads to central nervous system involvement. Although intracerebral bleeding is rare due to endemicity and a significant proportion of underdiagnoses, it should be considered a noteworthy differential diagnosis in endemic regions in patients with relevant history and clinical findings.Case presentationWe present the case of a 40-year-old Nepali woman who visited the emergency department with complaints of left-sided weakness for 6 hours and an acute febrile illness with an eschar for 7 days and was diagnosed with scrub typhus by immunoglobulin M enzyme-linked immunosorbent assay of the serum. Imaging revealed a right-sided frontotemporal hematoma, and further examination revealed pulmonary edema with multiple organ dysfunction syndrome. The patient was mechanically ventilated and was treated with antibiotics, steroids, vasopressors, and antipyretics. However, the hematoma was treated conservatively, with ongoing neurological recovery at the 6-month follow-up.ConclusionAlthough neurological complications and intracranial hemorrhage are uncommon, physicians must be cautious when making differential diagnoses and initiating appropriate therapies to avoid serious or fatal complications.

A chronic encapsulated expanding hematoma that developed 20 years after gamma knife surgery for a cerebral epilepsy

Background:We report a patient diagnosed with epilepsy 20 years ago who developed a chronic encapsulated expanding hematoma after gamma knife surgery. Case presentation:A 49-year-old middle-aged female was admitted to our department due to headaches accompanied by left-sided limb weakness for 2 months. Cranial computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed a giant cystic-solid mass in the right frontal-temporal lobe, accompanied by compression and edema of the surrounding brain parenchyma. After completion of relevant preoperative examinations upon admission, she underwent microsurgical evacuation of the chronic encapsulated expanding intracerebral hematoma. Postoperatively, the patient improved and recovered well. Conclusion:Chronic encapsulated expanding hematoma is a rare complication after gamma knife surgery therapy. It's essential for individuals experiencing symptoms or complications related to a hematoma to seek medical attention for proper evaluation and management.

Fungal carotiditis with aneurysm - a rare complication of mucormycosis: presentation and management

During the COVID-19 pandemic, cases of mucormycosis (ROCM) had increased drastically, especially in the second wave. Most of these cases involved the paranasal sinuses, orbit and occasionally brain. This case report presents a rare case of mucormycosis complicated with a mycotic aneurysm of the petrous part of the internal carotid artery (ICA). A 43-year-old man presented with left-sided facial weakness for which high resolution computed tomography scan of the Temporal bones was done. A scrutiny of the computed tomography temporal bone showed evidence of osteomyelitis extending to the petrous apex around the foramen Lacerum. Computed tomography and magnetic resonance imaging of the paranasal sinus done later confirmed the diagnosis of mucormycosis. The patient underwent endoscopic surgical debridement of the nose and sinuses, with post-operative amphotericin B. After 3 weeks, the patient presented with bouts of profuse nasal bleed. Computed tomography angiogram showed an aneurysm in the petrous segment of the ICA suggestive of mycotic carotiditis complicated from mucormycosis spread along the skull base. It was successfully managed neurosurgically by a bypass shunting procedure. Mucormycosis is a disease that typically has an aggressive and startling fatality rate. ICA aneurysm is an uncommon occurrence in mucormycosis. Subjects with ROCM should be examined for brain and vascular involvement. Computed tomography angiogram should be performed as soon as possible if the skull base is involved in the ICA area. Morbidity and mortality can often be reduced by early diagnosis and interventions by a multidisciplinary team.

Minimally invasive resection of intracranial lesions using tubular retractors: A single surgeon series

ObjectiveTubular retractors are increasingly used due to their low complication rates, providing easier access to lesions while minimizing trauma from brain retraction. Our study presents the most extensive series of cases performed by a single surgeon aiming to assess the effectiveness and safety of a transcortical-transtubular approach for removing intracranial lesions. MethodsWe performed a retrospective review of patients who underwent resection of an intracranial lesion with the use of tubular retractors. Electronic medical records were reviewed for patient demographics, preoperative clinical deficits, diagnosis, preoperative and postoperative magnetic resonance imaging (MRI) scans, lesion characteristics including location, volume, extent of resection (EOR), postoperative complications, and postoperative deficits. Results112 transtubular resections for intracranial lesions were performed. Patients presented with a diverse number of pathologies including metastasis (31.3 %), GBM (21.4 %), and colloid cysts (19.6 %) The mean pre-op lesion volume was 14.45 cm3. A gross total resection was achieved in 81 (71.7 %) cases. Seventeen (15.2 %) patients experienced early complications which included confusion, short-term memory difficulties, seizures, meningitis and motor and visual deficits. Four (3.6 %) patients had permanent complications, including one with aphasia and difficulty finding words, another with memory loss, a third with left-sided weakness, and one patient who developed new-onset long-term seizures. Mean post-operative hospitalization length was 3.8 days. ConclusionTubular retractors provide a minimally invasive approach for the extraction of intracranial lesions. They serve as an efficient tool in neurosurgery, facilitating the safe resection of deep-seated lesions with minimal complications.

Vessel wall imaging in the diagnosis of antiphospholipid syndrome presenting as Moyamoya syndrome-A case report.

Objectives: We describe a case of anti-phospholipid syndrome (APLS) vasculopathy presenting with Moyamoya syndrome (MMS) and show the associated intracranial vessel wall MRI (VWI) findings. Methods: A 37-year-old-woman presented with acute onset dizziness and left-sided weakness. Neurologic exam revealed a left facial droop and left hemiparesis. She underwent a comprehensive laboratory work-up for stroke. Neuroimaging included a CT head, CT angiogram, VWI, and digital subtraction angiography. Results: Work-up revealed a triple-positive APLS antibody profile. CT of the head showed an acute right basal ganglia infarction and right frontal subarachnoid hemorrhage. CT angiogram revealed severe stenosis of the right internal carotid artery terminus in a Moyamoya pattern. Intracranial VWI showed long-segment concentric vessel wall thickening and homogeneous vessel wall enhancement and T2-hyperintense wall edema of the stenotic right ICA terminus, M1 middle cerebral artery, and A1 anterior cerebral artery. She was treated with long-term anticoagulation with warfarin and a right superficial temporal artery to middle cerebral artery bypass. Discussion: We present intracranial VWI features of vessel wall pathology in a patient with primary APLS presenting with MMS.

Primary intracranial malignant melanoma in an adolescent female: a case report

BackgroundPrimary central nervous system melanoma is an extremely rare entity and even rarer in children and adolescents as compared to adults. It is often difficult to consider a diagnosis of intracranial melanoma pre-operatively without any clinical evidence of neurocutaneous melanosis.Case presentationHerein, a case of primary melanoma of the brain is reported in a 17-year-old female who presented with headache, vomiting, and focal neurological deficit in the form of left-sided facial palsy and limb weakness. A contrast-enhanced computed tomography of head was performed which revealed a heterogeneously hyperattenuating mass lesion at left gangliocapsular region showing peripheral enhancement with internal non-enhancing cystic component. The patient underwent left frontotemporal craniotomy. The diagnosis was made on histopathological examination, which showed an invasive tumor comprising of epithelioid to spindled cells arranged in sheets, nests, and singly scattered. The special stains and immunohistochemical markers proved very helpful in establishing the diagnosis.ConclusionsThe case highlights the uncommon occurrence of primary intracranial melanoma in the pediatric age group, the perplexing histological features, and the rapid and fatal course.

Influence of partial resection on survival in glioblastoma: a case report

Glioblastoma, known for its aggressive behavior and poor prognosis, presents a formidable challenge in the realm of neuro-oncology. The conventional treatment paradigm for glioblastoma typically involves maximal safe surgical resection followed by adjuvant chemotherapy and radiation therapy, with the overarching goal of prolonging survival and mitigating symptom burden. Despite the concerted efforts directed towards these therapeutic modalities, the overall prognosis for glioblastoma patients remains dismal, particularly in cases where only partial tumor resection can be achieved. This case study seeks to explore the impact of partial resection on survival outcomes in individuals diagnosed with glioblastoma. A 44-year-old male presented with a constellation of symptoms including impaired speech, recurrent headaches, weekly seizures, and left-sided weakness. Due to the tumor’s location near the motor strip, which posed a significant risk for neurological deficits, a decision was made to pursue partial resection, resulting in the removal of approximately 74 % of the tumor mass. Subsequent to the surgical intervention, the patient underwent a six-week course of chemotherapy utilizing temozolomide (75 mg/m2), albeit without adjunctive radiation therapy. Notably, the patient experienced improvement in symptomatology following the completion of therapy and demonstrated a survival duration of five months post-diagnosis.This case serves to underscore the potential therapeutic utility of partial resection as a viable treatment approach for glioblastoma, particularly in scenarios where achieving total tumor excision is deemed unattainable due to critical anatomical considerations. Furthermore, it underscores the imperative of individualized treatment strategies tailored to each patient’s unique clinical circumstances. Moreover, it emphasizes the critical need for ongoing research endeavors aimed at refining treatment approaches and improving outcomes for glioblastoma patients, particularly those with unfavorable prognostic profiles.

Sentinel report of uniquely paired collision tumors: glioblastoma multiforme and coexistent intraventricular subependymoma. Illustrative case.

The presence of intracranial collision tumors, histologically distinct tumors occurring in anatomical proximity, is quite rare. Herein, the authors describe the sentinel case of a contiguous collision tumor combination consisting of glioblastoma multiforme and intraventricular subependymoma. A 67-year-old male presented with several months of progressive fatigue superimposed on more recently noted word-finding difficulty, slight left-sided weakness, and episodic confusion. He was found to have a large right frontal mass abutting the right lateral ventricle with an additional nodular focus of enhancement within the right frontal horn. The patient underwent an awake right frontal craniotomy for gross-total resection of the tumor, noted to be of two distinct histological identities. Although exceptionally rare, primary glial neoplasms of various histologies can be encountered simultaneously during resection, as in this case of co-occurring glioblastoma of the right frontal lobe and right frontal horn intraventricular subependymoma. Close attention to tumoral locations and the gross appearance of specimens during resection can prime the operative neurosurgeon for success in contributing to accurate diagnoses through sending separate pathological specimens for histological analysis when qualitatively different tissue is suspected.

Case Report: Comprehensive management of Bulbar Motor Neuron disease in an elderly male: A Multidisciplinary case report approaching the treatment

Abstract* Bulbar Motor Neuron Disease (MND), a specific form of amyotrophic lateral sclerosis (ALS) primarily affecting the upper and lower motor neurons in the brainstem’s bulbar region, presents a significant challenge in clinical management. This case report delves into the clinical presentation and management of an 85-year-old male patient with typical symptoms, such as left-sided weakness, dysphagia, and dysarthria, along with a history of aphasia and hypertension, underlining the complexities associated with diagnosing and managing this condition. Methods: The patient underwent a thorough clinical examination, diagnostic investigations, and imaging, leading to a confirmed diagnosis of bulbar MND. Multidisciplinary interventions were employed to addressed the diverse symptoms, including compensation therapy, swallowing function training, physiotherapy, bolus modification, behavioral adjustments, oromotor exercises, postural corrections, and sensory and neurophysiologic stimulation to enhance swallowing safety and comfort. Additionally, interventions for dysarthria and left-sided weakness encompassed speech rate control, strength training, and the use of augmentative communication aids. Results: Over a 30-day follow-up period, the patient showed improvements in dysphagia, dysarthria, and activities of daily living. The treatment strategies effectively addressed the specific challenges associated with bulbar MND, focusing on enhancing the patient’s quality of life and functional abilities. Conclusions: This case report underscores the need for a comprehensive, multidisciplinary approach to manage bulbar MND. It highlights the complexities of diagnosing and addressing the diverse symptoms and difficulties that patients with this condition encounter, emphasizing the importance of a holistic and individualized therapeutic strategy.

Surgical management of stylocarotid Eagle syndrome in a patient with bilateral internal carotid artery dissection: illustrative case.

Eagle syndrome is characterized by an elongated styloid process, which can cause acute neurological symptoms when the projection impinges on local structures. One method by which Eagle syndrome can cause acute stroke is via internal carotid artery dissection. A patient presented with acute aphasia and right-arm weakness. Imaging revealed a left internal carotid artery dissection, which was treated with stenting. Three years later, the patient presented with left-sided weakness, and imaging revealed a new right internal carotid artery dissection. Closer review of the patient's imaging revealed bilateral elongated styloid processes. The patient subsequently underwent staged bilateral styloidectomy and returned to his prior baseline postoperatively. This case report describes a patient with Eagle syndrome who had two internal carotid artery dissections separated by several years. A literature review revealed that styloidectomy is well tolerated in patients with carotid dissection due to Eagle syndrome. Patients with carotid dissection due to Eagle syndrome remain at risk for contralateral dissection, and prophylactic contralateral styloidectomy should be considered.

Exploring thrombus composition in cerebral venous thrombosis: the first case report with initial insights and implications for treatment advancements.

Endovascular thrombectomy (EVT) is a treatment option in patients with a cerebral venous thrombosis (CVT) who deteriorate despite anticoagulant treatment. Assessment of thrombus composition in CVT may provide insights into the pathophysiology of the disease and suggest new therapeutic strategies. A 47-year-old woman (smoking habit and estradiol/progesterone-releasing intra-uterine device) diagnosed with massive CVT underwent EVT (complete recanalization via aspiration catheter and stentriever) due to acute-onset left-sided weakness and dysarthria despite 72 h of full-dose subcutaneous low-molecular heparin. Two main reddish clots (maximum diameter 15 mm) were retrieved. Microscopic assessment showed an erythrocyte-rich thrombus (83.9% of entire thrombus surface) with layers of platelets/fibrin (lines of Zahn: 13.9% fibrin and 38.5% platelet [CD61+]). The immunological profile was dominated by neutrophils (30% MPO+), with neutrophil extracellular traps (NETs) in 1.9% of thrombus surface. T- (CD3+), B-lymphocytes (CD20+), and monocytes/macrophages (CD68+) were rather rare (2.2%, 0.7%, and 2.0% respectively). We found no evidence (0.0%) of hemosiderin and endothelial cells (CD34+). Full clinical recovery occurred prior to discharge. This is the first case report of a CVT with histologic assessment of the thrombus retrieved via EVT. Evaluating thrombi in CVT can provide key insights into disease pathophysiology and guide treatment advancements.

EFFECTS OF RELAXING MUSIC THERAPY ALONG WITH TASK-ORIENTED TRAINING OF LOWER LIMB ON BALANCE AND FUNCTIONAL INDEPENDENCE IN PATIENTS WITH CHRONIC STROKE: A RANDOMIZED CLINICAL TRIAL

Background of the Study: To compare the effects of relaxing music therapy with task-oriented training of lower limbs on the balance and functional status in patients with chronic stroke. Methodology: This randomized clinical trial was conducted in three outpatient physiotherapy clinics in Lahore, Pakistan. A sample of 76 participants with chronic stroke, aged 40-60 years, and on assistance walking, were recruited through a purposive sampling technique. Individuals who had physical impairments and visual or hearing deficits were not included in the study. Group A received task-oriented training with routine physical therapy while Group B received Music therapy additionally. Three sessions on alternate days per week for eight weeks were given. Balance and functional independence were the outcome variables measured using the Berg Balance Scale and Functional Independence Measure respectively. Mann-Whitney U test and Friedman ANOVA were applied for between-group and within-group differences respectively. P-value was significant at ≤0.05. Results: The mean age of participants was 54.05 ± 3.64 years, the majority i.e., 55 (72.4%) were male, 46 (60.5%) had ischemic stroke and 53 (69.7%) were presented with left-sided weakness. A statistically significant difference was observed among both groups in balance (p =.000) and functional independence (p=0.000). The within-group difference was also significant for balance (p=0.000) and functional independence (p=0.000). Conclusion: The integration of relaxing music therapy, task-oriented training, and routine physiotherapy is effective in improving balance and functional independence in chronic stroke patients. Keywords: Balance, berg balance scale, functional independence, functional independence measure, music therapy, coordination impairment.

Challenge of Case 18: A 66-Year-Old Woman With Dizziness and Left Side Weakness

Challenge of Case 18: A 66-Year-Old Woman With Dizziness and Left Side Weakness

Pancreatic cancer with multiple liver metastasis complicating multi organ infarcts from Marantic endocarditis and Trousseau’s syndrome

Background: Marantic endocarditis and Trousseau’s syndrome are historically linked with pancreatic cancer. The patient had catastrophic embolic events which caused multi organ infarct due to underlying advanced pancreatic cancer. Doctors should be aware of early signs and symptoms of pancreatic cancer and conduct necessary clinical assessments and investigations that can prevent any severe complications. Case Presentation: A middle-aged healthy gentleman who presented with left-sided weakness, slurred speech, left-sided sensory neglect, mild headache, and fever. CT head showed acute right-sided temporal ischemic changes with subsequent magnetic resonance imaging (MRI) head showed multiple infarcts in the brain. A transesophageal echocardiogram reported possible MV vegetation. MRI of the liver was done due to deranged LFTs which showed multiple liver metastasis with a primary mass in the tail of the pancreas. Left leg ultrasound Doppler showed a large left leg deep vein thrombosis involving the femoral vein as he complained of left leg pain for 2 months and went to GP with right leg pain 3 months ago which was treated as a right ankle sprain. The clinical events explained that most likely he developed Trousseau’s syndrome 3 months ago and the embolic phenomena were due to rare Marantic endocarditis (Non-bacterial thrombotic endocarditis) secondary to pancreatic cancer. Ultrasound-guided biopsy of liver metastasis was planned, but sadly the patient passed away the next day. Conclusion: The diagnosis of early pancreatic cancer with imaging poses a challenge sometimes, therefore the pancreatic protocol of CT or MRI is the first line of investigation. Moreover, the cause of unprovoked thrombo-embolism should be investigated to rule out any underlying malignancy.

HYPERDENSE BASILAR ARTERY SIGN IN ISCHEMIC STROKE PATIENT WITH COVID-19: A CASE REPORT

Background: Coronavirus disease 2019 (COVID-19) can cause coagulopathy, leading to thromboembolism disease such as ischemic stroke. Ischemic stroke due to basilar artery occlusion (BAO) is rare condition, which is hard to diagnose and has high mortality especially if accompanied by COVID-19. Objective: To evaluate the presence of infarction in the basilar area in COVID-19 patients and prevent complications that arise due to misdiagnosis Methods: 41 year old male patient came to the emergency unit with left-side weakness, slurred speech, vertigo, and nausea 7 hours before admission. He also had mild fever, cough, and fatigue a week before admission. Patient had full consciousness, blood pressure 180/100, left hemiparesis (motoric 3/5), dysarthria, dysphagia. His National Institutes of Health Stroke Scale (NIHSS) score was 7. Results: From laboratory examination, neutrophil lymphocyte ratio (NLR) was increased to 3.60, he tested positive for SARS-CoV-2 rapid antigen and Polymerase Chain Reaction (PCR) with cycle threshold (CT) value 28.66, and D-dimer was increased to 4000 ng/mL. Bronchovascular markings increased on chest X-ray and hyperdense bacillary artery sign found on head CT-scan suggesting vertebrobasilar infarct. Acute stroke ischemic due to large vessel occlusion in COVID-19 found more often in young men with mild symptoms or asymptomatic COVID-19. Prodromal symptoms and stroke onset in BAO can be atypical and variable. Hyperdense bacillary artery sign on head CT scan was a specific sign and can support the diagnosis of BAO. Concussion: Patient’s condition got better progressively and was allowed to discharge from hospital after 6 days. BAO patients with younger age, lower NIHSS scores, early diagnosis, and prompt treatment had better prognosis.

Recurrent Transient Ischemic Attack in the Elderly due to Asymptomatic Atrial Septal Defect: An Unusual Scenario

Atrial septal defects (ASD) are congenital cardiac anomalies, characterized by abnormal communication between the atria. These are commonly diagnosed in childhood and occasionally remain asymptomatic and undetected until the later stages of life. In ASD, there is communication between atria. Until the 4th decade of life, the majority of ASD are asymptomatic. Some exhibit the signs of exhaustion, syncope, exercise intolerance, and dyspnea with effort. Eisenmenger syndrome, paradoxical embolism, and atrial arrhythmias are among the problems that some people may later on develop. We describe a particular case of a 70-year-old male who arrived with a transient ischemic attack where he had left-sided upper limb weakness due to a paradoxical embolism due to ASD.

The Effectiveness of Transcranial Magnetic Stimulation in Post Stroke Dysphagia, A Case Report

Background: A 72-year-old male, experiencing dysphagia and left-sided weakness for six months post-stroke, encountered challenges such as coughing and choking during the consumption of liquids and soft foods, along with a prolonged meal-swallowing process. Bilateral thrombotic infarction and left lateralization were revealed through Magnetic Resonance Imaging (MRI). Case: The Gugging Swallowing Screening Scale (GUSS) assessment demonstrated severe impairment with a total score of 7, persisting despite conventional physiotherapy attempts to improve swallowing function. Subsequently, repetitive transcranial magnetic stimulation (rTMS) was implemented, involving high-intensity stimulation in the ipsilesional hemisphere and low-intensity stimulation in the contralesional hemisphere. Remarkably, one month post-rTMS, the patient displayed significant progress, evidenced by an improved GUSS score of 15, indicating enhanced swallowing function. Discussion: This case emphasizes the positive impact of bilateral rTMS hemispheric stimulation on post-stroke dysphagia. The strategic application of high-intensity ipsilesional and low-intensity contralesional stimulation emerged as an effective intervention for alleviating swallowing difficulties. These findings highlight the potential of rTMS as an innovative therapeutic approach for persistent dysphagia following a stroke.