Cricopharyngeal dysfunction in lateral medullary syndrome

Abstract

Background: Dysphagia is a common consequence of medullary stroke, and it is particularly true in Lateral medullary syndrome (LMS). Aims: To compare the lateral medullary syndrome (LMS) to the middle cerebral artery infarct (MCA) population to study the swallowing dysfunction at the oral, pharyngeal, and esophageal level using flexible endoscopic evaluation of swallowing (FEES) and video-flouroscopic swallowing study (VFS). Materials and Methods: The swallowing characteristics in 16 patients (11 men and five women) with a mean age of 61.8 (range 44-78 years), with left LMS were compared with 18 patients (13 men and five women) with unilateral hemispheric infarction (left MCA), with a mean age of 58.2 (range 37-75). The swallowing characteristics were recorded and analysed. Results and Discussion: All LMS patients considered for this study had pharyngeal and proximal esophageal stage dysphagia. Swallowing difficulties noted were delayed pharyngeal swallow reflex, cricopharyngeal dysfunction, pooling in post-cricoid region (left > right side), and multiple swallows to clear bolus. All patients with L MCA infarct had difficulty with oral and pharyngeal stage dysphagia. All left MCA infarct patients showed delay in oral transit time, laryngeal penetration and aspiration. Conclusion: A substantial uniformity of pathophysiological characteristics was found. The pharyngeal and proximal esophageal stage of swallowing was affected in left LMS, but both oral and pharyngeal stage of swallowing was affected in left MCA infarct. Cricopharyngeal dysfunction was a typical finding in LMS, although severity varied. Because severe dysphagia is very common in stroke, active swallowing diagnostic and therapeutic approaches are needed.