Case Report

Dysphagia

, Volume 24, Issue 2, pp 238-245

First online:

Impaired Opening of the Upper Esophageal Sphincter in Patients with Medullary Infarctions

  • Ren-Xiu BianAffiliated withDepartment of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital
  • , In-Sung ChoiAffiliated withDepartment of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital
  • , Jae-Hyung KimAffiliated withDepartment of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital
  • , Jae-Young HanAffiliated withDepartment of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital
  • , Sam-Gyu LeeAffiliated withDepartment of Physical and Rehabilitation Medicine, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital Email author 

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Abstract

The aim of this study was to report on nine dysphagic patients with medullary infarction and to evaluate swallowing characteristics based on the location of the lesions.We retrospectively reviewed the medical records of these nine patients. The medullary lesions were midlateral (three patients), dorsolateral (one patient), inferodorsolateral (four patients), and paramedian (one patient). The levels of the lesions were upper (four patients), middle (two patients), upper and middle (two patients), and middle and lower medulla (one patient). Dysphagia after medullary infarction was more common in patients with upper or middle medullary level and dorsolateral medullary level lesions. The common findings on videofluoroscopic swallowing studies in patients with lateral medullary infarctions were impaired upper esophageal sphincter opening, aspiration from pyriform sinuses’ residue caused by pharyngeal weakness, and multiple swallowing to clear boluses from the pharynx to the esophagus. In patients with medullary infarctions, the lesion levels and loci and their related clinical findings can be useful in predicting dysphagia and aspiration. Because severe dysphagia with serious complication is very common in patients with medullary infarctions, active diagnostic and therapeutic approaches are needed.

Keywords

Deglutition Deglutition disorders Stroke Medulla oblongata Upper esophageal sphincter Outcome