Bulbar syndrome as a manifestation of exacerbation of multiple sclerosis, simulating acute cerebrovascular accident

Background. Bulbar syndrome is a clinical condition characterized by impairment of swallowing, phonation and articulation caused by dysfunction of cranial nerve nuclei and brainstem neural networks. In emergency practice, the acute onset of bulbar symptoms is most commonly associated with stroke in the circulation. However, demyelinating diseases of the central nervous system, particularly multiple sclerosis, may rarely pre­sent with bulbar manifestations, creating significant diagnostic challenges in emergency departments. Objective: to analyze the clinical, neuroanatomical and neuroimaging features of bulbar syndrome as a manifestation of multiple sclerosis relapse mi­micking acute cerebrovascular disease. Materials and methods. We present a clinical case of a patient with acute onset of dysarthria and dysphagia initially suspected to have brainstem stroke. The diagnostic workup included comprehensive neurological examination, computed tomography, magnetic resonance imaging of the brain, laboratory investigations and clinical follow-up. A review of contemporary literature on bulbar dysfunction in multiple sclerosis was also performed. Results. Magnetic resonance imaging revealed demyelinating lesions within the brainstem consistent with multiple sclerosis. The clinical presentation included dysarthria, dysphagia and dysphonia without evidence of acute ischemia. High-dose corticosteroid therapy resulted in significant neurological improvement. Literature review has shown that that damage to the structures of the medulla oblongata in multiple sclerosis can lead to dysfunction of the nucleus tractus solitarius, nucleus ambiguus, and corticobulbar pathways, which clinically manifest as bulbar syndrome. Conclusions. Bulbar syndrome may represent a rare manifestation of exacerbation of multiple sclerosis and mimic brainstem stroke. Magnetic resonance imaging and careful clinical evaluation are crucial for differential diagnosis. Inclusion of demyelinating disorders in the diagnostic algorithm of acute bulbar symptoms may improve clinical decision-making and optimize patient management in emergency settings.