Abstract
Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.
Highlights
Swallowing mechanism is a sequential event of oral, pharyngeal, and esophageal phases that transports saliva, ingested solids, and fluid from mouth to the stomach and protects the airways during swallowing
About 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 40%– 47% of the patients suffer from dysphagia [1]
Dysphagia following brainstem stroke is characteristically associated with a greater likelihood of occurrence, showing signs of most severe form of dysphagia, compared to hemispheric strokes [2]
Summary
Swallowing mechanism is a sequential event of oral, pharyngeal, and esophageal phases that transports saliva, ingested solids, and fluid from mouth to the stomach and protects the airways during swallowing. Dysphagia following a lateral medullary stroke (LMS) is often more severe and spontaneous recovery may not completely restore the swallowing function. It may persist for life time or may take months or years to resolve [2]. VitalStim therapy is a special form of neuromuscular electrical stimulation (NMES) device, which has received FDA clearance to be used for treatment of pharyngeal dysphagia. It can only be administered under the direction of certified healthcare professionals This case study aims to document the severity and the advanced technological management of dysphagia in lateral medullary infarct
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