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Oropharyngeal dysphagia in secondary normal pressure hydrocephalus due to corticobulbar tract compression: cases series and review of literature

  • Case Report - Functional
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Abstract

The association and mechanism involved in swallowing disturbance and normal pressure hydrocephalus (NPH) needs to be established. We report a case report where a patient who showed progressive swallowing dysfunction was diagnosed with secondary NPH. Tractography analysis showed corticobulbar tract compression by ventricular dilation. Drainage operation led to the recovery of tract volume with an improvement of swallowing function. We also report ten case series in which secondary NPH was associated with a swallowing disturbance. In these cases, dysphagia also showed improvement after shunt operation. We review the literature regarding the corticobulbar tract and its association with swallowing disturbance and the possible underlying pathophysiological mechanism in secondary NPH. This report highlights that swallowing disturbance may manifest in those with secondary NPH due to corticobulbar tract involvement. Our findings suggest that involvement of the corticobulbar tract may be a possible cause of dysphagia in secondary NPH that may be reversible after shunt operation.

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Abbreviations

NPH:

Normal pressure hydrocephalus

CBT:

Corticobulbar tract

DTI:

Diffusion tensor imaging

FOIS:

Functional Oral Intake Scale

mRS:

Modified Rankin Scale

VFSS:

Videofluoroscopic Swallowing Study

VDS:

Videofluoroscopic Dysphagia Scale

MBSImP™:

Modified Barium Swallow Impairment Profile©

CT:

Computed tomography

ROI:

Regions of interest

CSF:

Cerebrospinal fluid

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Authors and Affiliations

  1. Department of Neurosurgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Bucheon-si, Gyeonggi-do, 14647, South Korea

    Kwang Wook Jo & Ik Seong Park

  2. Department of Rehabilitation Medicine, RHIIN Hospital, Youngin-si, PoeunDero, Gyeonggi-do, 118-61, South Korea

    Youngkook Kim

  3. Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Bucheon-si, Gyeonggi-do, 14647, South Korea

    Geun-Young Park, Yongjun Jang, Sohn Dong Gyun & Sun Im

Authors
  1. Kwang Wook Jo
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  2. Youngkook Kim
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  3. Geun-Young Park
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  4. Ik Seong Park
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  5. Yongjun Jang
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  7. Sun Im
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Correspondence to Sun Im.

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Comments

In this case report, the authors describe dysphagia in a patient with normal pressure hydrocephalus (NPH) and the results of corresponding diffusion tensor imaging (DTI). The authors employed the DTI technique in an attempt to reveal the neuroanatomical correlate that is engaged in the NPH dysphagia. Their findings are of some interest: the preoperative DTI showed reduced volume of the corticobulbar tracts (CBT) and a CBT volume increase following insertion of a ventriculoperitoneal (VP) shunt, which caused improvement of the swallowing problems. However, my advice is to interpret the results of this single case report with some caution; the patient can hardly be said to be a “pure” NPH patient, as he already was seriously impaired by a previous brain injury leaving marked asymmetrical structural changes in his brain. The neuroimaging observations in this patient may well reflect the mechanisms behind NPH-related dysphagia, but these preliminary results should be confirmed in a larger series of NPH patients without any additional encephalopathy before drawing any firm conclusions.

Knut Wester

Bergen, Norway

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Jo, K., Kim, Y., Park, GY. et al. Oropharyngeal dysphagia in secondary normal pressure hydrocephalus due to corticobulbar tract compression: cases series and review of literature. Acta Neurochir 159, 1005–1011 (2017). https://doi.org/10.1007/s00701-017-3157-5

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  • DOI: https://doi.org/10.1007/s00701-017-3157-5

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