A 69-year-old male was brought to the neurology clinic for the complaints of increasingly strange behavior observed by neighbors, audible upper airway noises and changes in the tone of his speech. On examination, he was a mildly cachexic man with obvious difficulties in swallowing his saliva. There were audible bubbling noises emanating from his upper airway and he was drooling at the mouth. On auscultation of the lungs, there were widespread crackles faintly audible above the upper airway noises.
Upon interrogation, he reported having chronic low back pain and heel pain. The radiograph of the foot showed calcaneal spurs and Achilles calcification. The physician suspects the diagnosis of diffuse idiopathic skeletal hyperostosis (DISH).
