An 89-year-old left-handed man presented with a two-month history of difficulty swallowing after an operation for a left retinal detachment. He described choking. He had particular difficulty with crumbs. He had nasal regurgitation. A speech and language therapist confirmed problems with the pharyngeal phase of his swallowing, in that there was incomplete pharyngeal swallow, severe pharyngeal dysphagia and an aspiration risk. The patient had also noticed over the same two months that as he talked his speech became slurred. He had no breathing or walking difficulties and denied any diplopia, blackouts or dry mouth.