, Volume 9, Issue 4, pp 245–255 | Cite as

Neurogenic dysphagia: What is the cause when the cause is not obvious?

  • David W. Buchholz


The potential causes of neurogenic oropharyngeal dysphagia in cases in which the underlying neurologic disorder is not readily apparent are discussed. The most common basis for unexplained neurogenic dysphagia may be cerebrovascular disease in the form of either confluent periventricular infacts or small, discrete brainstem stroke, which may be invisible by magnetic resonance imaging. The diagnosis of occult stroke causing pharyngeal dysphagia should not be overlooked, because this diagnosis carries important treatment implications. Motor neuron disease producing bulbar palsy, pseudobulbar palsy, or a combination of the two can present as gradually progressive dysphagia and dysarthria with little if any limb involvement. Myopathies, especially polymyositis, and myasthenia gravis are potentially treatable disorders that must be considered. A variety of medications may cause or exacerbate neurogenic dysphagia. Psychiatric disorders can masquerade as swallowing apraxia. The basis for unexplained neurogenic dysphagia can best be elucidated by methodical evaluation including careful history, neurologic examination, videofluoroscopy of swallowing, blood studies (CBC, chemistry panel, creatine kinase, B12, thyroid screening, and anti-acetylcholine receptor antibodies), electromyography, and magnetic resonance imaging (MRI) of the brain, plus additional procedures such as lumbar puncture and muscle biopsy as indicated. Little is known about aging and neurogenic dysphagia, specifically the relative contributions of natural age-related changes in the oropharynx and of diseases of the elderly, including periventricular MRI abnormalities, in producing dysphagia symptoms and videofluoroscopic abnormalities in this population.

Key words

Neurogenic dysphagia Oropharyngeal dysfunction Videofluoroscopy Deglutition Deglutition disorders 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Buchholz D: Neurologic evaluation of dysphagia. Dysphagia 1:187–192, 1987Google Scholar
  2. 2.
    Buchholz DW, Bosma JF, Donner MW: Adaptation, compensation and decompensation of the pharyngeal swallow. Gastrointest Radiol 10:235–239, 1985Google Scholar
  3. 3.
    Horner J, Massey EW: Silent aspiration following stroke. Neurology 38:317–319, 1988Google Scholar
  4. 4.
    Kahrilas PJ: The anatomy and physiology of dysphagia. In: Gelfand DW, Richter JE (eds.): Dysphagia: Diagnosis and Treatment New York: Igaku-Shoin, 1989Google Scholar
  5. 5.
    Donner MW, Siegel CI: The evaluation of pharyngeal neuromuscular disorders by cinefluorography. Am J Roentgenol 94:299–307, 1965Google Scholar
  6. 6.
    Donner MW, Silbiger ML, Cooley R: Cinefluorographic analysis of swallowing in neuromuscular disorders. Am J Med Sci 251:600–616, 1966Google Scholar
  7. 7.
    Silbiger ML, Pikielney R, Donner MW: Neuromuscular disorders affecting the pharynx: cineradiographic analysis. Invest Radiol 2:442–448, 1967Google Scholar
  8. 8.
    Margulies S, Brunt P, Donner M, Silbiger M: Familial dysautonomia: a cine-radiographic study of the swallowing mechanism. Radiology 90:107–112, 1968Google Scholar
  9. 9.
    Bosma JF, Brodie DR: Disabilities of the pharynx in ALS as demonstrated by cineradiography. Radiology 92:97–103, 1969Google Scholar
  10. 10.
    Bosma JF, Brodie DR: Cineradiographic demonstration of pharyngeal area myotonia in myotonic dystrophy patients. Radiology 92:104–109, 1969Google Scholar
  11. 11.
    Donner MW: Swallowing mechanism and neuromuscular disorders. Semin Roentgenol 3:273–282, 1974Google Scholar
  12. 12.
    O'Connor A, Ardran C: Cinefluorography in the diagnosis of pharyngeal palsies. J Laryngol Otol 90:1015–1019, 1976Google Scholar
  13. 13.
    Jones B, Donner MW: Examination of the patient with dysphagia. Radiology 167:319–326, 1988Google Scholar
  14. 14.
    Stroudley J, Walsh M: Radiological assessment of dysphagia in Parkinson's disease. Br J Radiol 64:890–893, 1991Google Scholar
  15. 15.
    Chen MYM, Peele VN, Donati D, Ott DJ, Donofri PD, Gelfand DW: Clinical and videofluoroscopic evaluation of swallowing in 41 patients with neurologic disease. Gastrointest Radiol 17:95–98, 1992Google Scholar
  16. 16.
    Chen MY, Ott DJ, Peele VN, Gelfand DW: Oropharynx in patients with cerebrovascular disease: evaluation with videofluoroscopy. Radiology 176:641–643, 1990Google Scholar
  17. 17.
    Zerhouni EA, Bosma JF, Donner MW: Relationship of cervical spine disorders to dysphagia. Dysphagia 1:129–144, 1987Google Scholar
  18. 18.
    Lazarus C, Logemann J: Swallowing disorders in closed head trauma patients. Arch Phys Med Rehabil 68:79–84, 1987Google Scholar
  19. 19.
    Winstein CJ: Neurogenic dysphagia: frequency, progression and outcome in adults following head injury. Phys Ther 63:1992–1997, 1983Google Scholar
  20. 20.
    Buchholz D: Neurologic causes of dysphagia. Dysphagia 1:152–156, 1987Google Scholar
  21. 21.
    Bartolome G, Buchholz D, Hannig C, Neumann S, Prosiegel M, Schröter-Morasch H, Wuttge-Hannig A (eds.): Diagnostik und Therapie neurologisch bedingter Schluckstörungen. Stuttgart: Gustav Fischer Verlag, 1993Google Scholar
  22. 22.
    Meadows JC: Dysphagia in unilateral cerebral lesions. J Neurol, Neurosurg Psychiatry 36:853–860, 1973Google Scholar
  23. 23.
    Willoughby EW, Anderson NE: Lower cranial nerve function in unilateral vascular lesions of the cerebral hemisphere. Br Med J 289:791–794, 1984Google Scholar
  24. 24.
    Veis S, Logemann J: Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil 66:372–375, 1985Google Scholar
  25. 25.
    Hewer RL, Wade DJ: Dysphagia in acute stroke. Br Med J 295:411–414, 1987Google Scholar
  26. 26.
    Gordon C, Langton-Hewer R, Wade DT: Dysphagia in stroke. Br Med J 295:411–414, 1987Google Scholar
  27. 27.
    Horner J, Massey EW, Riski JE, Lathrop DL, Chase KN: Aspiration following stroke: clinical correlates and outcome. Neurology 38:1359–1362, 1988Google Scholar
  28. 28.
    Horner J, Massey EW, Brazer SR: Aspiration in bilateral stroke patients. Neurology 40:1686–1688, 1988Google Scholar
  29. 29.
    Robbins J, Levine RL: Swallowing after unilateral stroke of the cerebral cortex: preliminary evidence. Dysphagia 3:11–17, 1988Google Scholar
  30. 30.
    Barer DH: The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry 52:236–241, 1989Google Scholar
  31. 31.
    Gresham SL: Clinical assessment and management of swallowing difficulties after stroke. Med J Aust 153:397–399, 1990Google Scholar
  32. 32.
    Horner J, Buoyer FG, Alberts MJ, Helms MJ: Dysphagia following brain-stem stroke: clinical correlates and outcome. Arch Neurol 48:1170–1173, 1991Google Scholar
  33. 33.
    Alberts MJ, Horner J, Gray L, Brazer SR: Aspiration after stroke: lesion analysis by brain MRI. Dysphagia 7:170–173, 1992Google Scholar
  34. 34.
    Shanahan T, Logemann J, Kahrilas P: Swallow function after left basal ganglion stroke (Abstract) Presented to Dysphagia Research Society, 1992Google Scholar
  35. 35.
    Celifarco A, Gerard G, Faegenburg D, Burakoff R: Dysphagia as the sole manifestation of bilateral strokes. Am J Gastroenterol 85:610–613, 1990Google Scholar
  36. 36.
    Kim WS, Buchholz D, Kumar AJ, Donner M, Rosenbaum AE: Magnetic resonance imaging for evaluating neurogenic dysphagia. Dysphagia 2:40–45, 1987Google Scholar
  37. 37.
    Kirkpatrick JB, Hayman LA: White-matter lesions in MR imaging of clinically healthy brains of elderly subjects: possible pathologic basis. Radiology 162:509–511, 1987Google Scholar
  38. 38.
    Hunt AL, Orrison WW, Yeo RA, Haaland KY, Rhyne RL, Gary PJ, Rosenberg GA: Clinical significance of MRI white matter lesions in the elderly. Neurology 39:1470–1474, 1989Google Scholar
  39. 39.
    Levine R, Robbins J, Maser A: Periventricular white matter changes and oropharyngeal swallowing in normal individuals. Dysphagia 7:142–147, 1992Google Scholar
  40. 40.
    Buchholz D: Editorial. Dysphagia 7:148–149, 1992Google Scholar
  41. 41.
    Buchholz DW: Clinically probable brainstem stroke presenting primarily as dysphagia and nonvisualized by MRI. Dysphagia 8:235–238, 1993Google Scholar
  42. 42.
    Salgado ED, Weinstein M, Furlan AJ, Modic MT, Beck GJ, Estes M, Awad I, Little JR: Proton magnetic resonance imaging in ischemic cerebrovascular disease. Ann Neurol 20:502–507, 1986Google Scholar
  43. 43.
    Alberts M, Faulstich M, Gray L: Sensitivity of magnetic resonance imaging in patients with acute stroke. Ann Neurol 28:258, 1990Google Scholar
  44. 44.
    Dworkin JP, Hartman DE: Progressive speech deterioration and dysphagia in amyotrophic lateral sclerosis: case report. Arch Phys Med Rehabil 60:423–425, 1979Google Scholar
  45. 45.
    Robbins J: Swallowing in ALS and motor neuron disorders. Neurol Clin 5:213–229, 1987Google Scholar
  46. 46.
    Wilson PS, Bruce-Lockhart FJ, Johnson AP: Videofluoroscopy in motor neurone disease prior to cricopharyngeal myotomy. Ann Royal College Surg Engl 72:345–377, 1990Google Scholar
  47. 47.
    Siegel CI, Honda M, Salik J, Mendeloff AI: Dysphagia due to granulomatous myositis of the cricopharyngeus muscle: physiological and cineradiographic studies prior to and following successful therapy. Trans Assoc Am Physicians 74:342–352, 1961Google Scholar
  48. 48.
    Hardy WE, Tulgan H, Haidak G, Budnitz J: Sarcoidosis: a case presenting with dysphagia and dysphonia. Ann Inter Med 66:353–357, 1967Google Scholar
  49. 49.
    Metheny J: Dermatomyositis: a vocal and swallowing disease entity. Laryngoscope 88:147–161, 1978Google Scholar
  50. 50.
    Dietz F, Logemann JA, Sahgal V, Schmid FR: Cricopharyngeal muscle dysfunction in the differential diagnosis of dysphagia in polymyositis. Arthritis Rheum 23:491–495, 1980Google Scholar
  51. 51.
    Cunningham J, Lowry L: Head and neck manifestations of dermatomyositis-poliomyositis. Otolaryngol Head Neck Surg 93:673–677, 1985Google Scholar
  52. 52.
    Kagen LJ, Hochman RB, Strong EW: Cricopharyngeal obstruction in inflammatory myopathy (polymyositis/dermatomyositis). Arthritis Rheum 28:630–636, 1985Google Scholar
  53. 53.
    Vencovsky J, Rehak F, Paco P, et al.: Acute cricopharyngeal obstruction in dermatomyositis. J Rheumatol 15:1016–1018, 1988Google Scholar
  54. 54.
    Darrow DH, Hoffman HT, Barnes GJ, Wiley CA: Management of dysphagia in inclusion body myositis. Arch Otolaryngol Head Neck Surg 118:313–317, 1992Google Scholar
  55. 55.
    Hughes D, Swann J, Gleeson J, Lee F: Abnormalities in swallowing associated with dystrophica myotonica. Brain 88:1037–1042, 1965Google Scholar
  56. 56.
    Siegel CI, Hendrix TR, Harvey JC: The swallowing disorder in myotonic dystrophica. Gastroenterology 50:541–550, 1966Google Scholar
  57. 57.
    Duranceau A, Jamieson G, Clermont FJ: Oropharyngeal dysphagia in patients with oculopharyngeal muscular dystrophy. Can J Surg 21:326–329, 1978Google Scholar
  58. 58.
    Pettengel K, Spitaels J, Simjee A: Dysphagia an dystrophica myotonica. S Afr Med J 78:113–114, 1985Google Scholar
  59. 59.
    Kiel DP: Oculopharyngeal muscular dystrophy as a cause of dysphagia in the elderly. J Am Gastroenterol So 34:144–147, 1986Google Scholar
  60. 60.
    Buckler R, Pratter M, Chad D, Smith T: Chronic cough as the presenting symptom of oculopharyngeal muscular dystrophy. Chest 95:921–922, 1989Google Scholar
  61. 61.
    Johnson ER, McKenzie SW: Kinematic pharyngeal transit time in myopathy: evaluation for dysphagia. Dysphagia 8:35–40, 1993Google Scholar
  62. 62.
    Branski D, Levy J, Globus M, Aviad I, Keren A, Chowers I: Dysphagia as a primary manifestation of hyperthyroidism. J Clin Gastroenterol 6:437–440, 1984Google Scholar
  63. 63.
    Murray JP: Deglutition in myasthenia gravis. Br J Radiol 35:43–52, 1962Google Scholar
  64. 64.
    Carpenter R, McDonald T, Howard F: The otolaryngologic presentation of myasthenia gravis. Laryngoscope 89:922–928, 1979Google Scholar
  65. 65.
    Kakigi R, Shibasaki H, Kuroda Y, et al.: Meige's syndrome associated with spasmodic dysphagia. J Neurol Neurosurg Psychiatry 46:589–590, 1983Google Scholar
  66. 66.
    Logemann JA: Dysphagia in movement disorders. Adv Neurol 49:307–316, 1988Google Scholar
  67. 67.
    Riski JR, Horner J, Nashold BS: Swallowing function in patients with spasmodic torticollis. Neurology 40:1443–1445, 1990Google Scholar
  68. 68.
    Horner J, Riski JE, Levitt-Ovelmen J, Nashold BS: Swallowing in torticollis before and after rhizotomy. Dysphagia 7:117–125, 1992Google Scholar
  69. 69.
    Horner J, Riski JE, Weber BA, Nashold BS: Swallowing, speech, and brainstem auditory-evoked potentials in spasmodic torticollis. Dysphagia 8:29–34, 1993Google Scholar
  70. 70.
    Camella CL, Tanner CM, DeFoor-Hill L, Smith C: Dysphagia after botulinum toxin injections for spasmodic torticollis. Neurology 42:1307–1310, 1992Google Scholar
  71. 71.
    Lieberman AN, Horowitz L, Redmond P, Pachter L, Lieberman I, Liebowitz M: Dysphagia in Parkinson's disease. Am J Gastroenterol 74:157–160, 1980Google Scholar
  72. 72.
    Schneider JS, Diamond SG, Markham CH: Deficits in orofacial sensorimotor function in Parkinson's disease. Ann Neurol 19:275–282, 1985Google Scholar
  73. 73.
    Robbins J, Logemann JA, Kirshner HS: Swallowing and speech production in Parkinson's disease. Ann Neurol 19:283–287, 1986Google Scholar
  74. 74.
    Croxson SCM, Pye I: Dysphagia as the presentin feature in Parkinson's disease. Geriatr Med 8:16, 1988Google Scholar
  75. 75.
    Bushmann M, Dobmeyer SM, Leeker L, Perlmutter JS: Swallowing abnormalities and their response to treatment in Parkinson's disease. Neurology 39:1309–1314, 1989Google Scholar
  76. 76.
    Volicer L, Seltzer B, Rheaume Y, et al.: Eating difficulties in patients with probable dementia of the Alzheimer type. J Geriatr Psychiatry Neurol 2:188–195, 1989Google Scholar
  77. 77.
    Schlider MA, Nagurney JT: Progressive supranuclear ophalmoplegia in association with cricopharyngeal dysfunction and recurrent pneumonia. JAMA 237:994–995, 1977Google Scholar
  78. 78.
    Daly DD, Code CF, Anderson HA: Disturbances of swallowing and esophageal motility in patients with multiple sclerosis. Neurology 12:250–256, 1962Google Scholar
  79. 79.
    Boucher RM, Hendrix RA: The otolaryngologic manifestations of multiple sclerosis. Ear, Nose Throat J 70:224–233, 1991Google Scholar
  80. 80.
    Frank Y, Schwartz SB, Epstein NE, Beresford HR: Chronic dysphagia, vomiting and gastroesophageal reflux as manifestations of a brain stem glioma: a case report. Pediatr Neurosci 15:265–268, 1989Google Scholar
  81. 81.
    Bleck TP, Shannon KM: Disordered swallowing due to a syrinx: correction by shunting. Neurology 34:1497–1498, 1984Google Scholar
  82. 82.
    Massey CE, El Gammal T, Brooks BS: Giant posterior inferior cerebellar artery aneurysm with dysphagia. Surg Neurol 22:467–471, 1984Google Scholar
  83. 83.
    Fernandez F, Leno C, Commbarros O, Berciano J: Cricopharyngeal dysfunction due to syringobulbia. Neurology 36:1635–1638, 1986Google Scholar
  84. 84.
    Achiron A, Kuritzky A: Dysphagia as the sole manifestation of adult type I Arnold-Chiari malformation. Neurology 40:186–187, 1990Google Scholar
  85. 85.
    Dalakas MC, Elder G, Hallett M, Ravits J, Baker M, Papadopoulos N, Albrecht P, Sever J: A long-term follow-up study of patients with post-poliomyelitis neuromuscular symptoms. N Engl J Med 314:959–963, 1986Google Scholar
  86. 86.
    Baker AB, Matzke A, Brown JR: Bulbar poliomyelitis: a study of medullary function. Arch Neurol Psychiatry 63:257–281, 1950Google Scholar
  87. 87.
    Bosma JF: Studies of disability of the pharynx resultant from poliomyelitis. Ann Otol Rhinol Laryngol 62:529–547, 1953Google Scholar
  88. 88.
    Buchholz D. Dysphagia in post-polio patients. In: Halstead LS, Wiechers DO (eds.). Research and Clinical Aspects of the Late Effects of Poliomyelitis. New York: March of Dimes, 1987Google Scholar
  89. 89.
    Coelho CA, Ferrante R: Dysphagia in postpolio sequelae: report of three cases. Arch Phys Med Rehabil 69:634–636, 1988Google Scholar
  90. 90.
    Buchholz D, Jones B: Dysphagia occurring after polio. Dysphagia 6:165–169, 1991Google Scholar
  91. 91.
    Sonies BC, Dalakas MC: Dysphagia in patients with the postpolio syndrome. N Engl J Med 324:1162–1167, 1991Google Scholar
  92. 92.
    Silbergleit AK, Waring WP, Sullivan MJ, Maynard FM: Evaluation, treatment and follow-up results of post-polio patients with dysphagia. Otolaryngol Head Neck Surg 104:333–338, 1991Google Scholar
  93. 93.
    Jones B, Buchholz DW, Ravich WJ, Donner MW: Swallowing dysfunction in the postpolio syndrome: a cineradiographic study. Am J Roentgenol 158:283–286, 1992Google Scholar
  94. 94.
    Buchholz DW, Jones B: Post-polio dysphagia: alarm or caution? J Orthop 14:1303–1305, 1991Google Scholar
  95. 95.
    Kikendall JW, Friedman AC, Oyewole MA, Fleischer D, Johnson LS: Pill-induced esophageal injury: case reports and review of the medical literature. Dig Dis 28:174–182, 1983Google Scholar
  96. 96.
    Ravich WJ, Kashima H, Donner MW: Drug-induced esophagitis simulating esophageal carcinoma. Dysphagia 1:13–18, 1986Google Scholar
  97. 97.
    Kuncl RW, Wiggins WW: Toxin myopathies. Neurol Clin 6:593–619, 1988Google Scholar
  98. 98.
    Massengill R, Nashold B: A swallowing disorder denoted in tardive dyskinesia patients. Acta Otolaryngol 68:457–458, 1969Google Scholar
  99. 99.
    Flaherty JA, Lahmeyer HW: Laryngeal-pharyngeal dystonia as a possible cause of asphyxia with haloperidol treatment. Clin Res Rep 135:1414–1415, 1978Google Scholar
  100. 100.
    Craig T, Richardson T: Swallowing, tardive dyskinesia, and anticholinergics. Am J Psychiatry 139:1083, 1982Google Scholar
  101. 101.
    Craig TJ, Richardson MA, Bark NM, Klebanov R: Impairment of swallowing, tardive dyskinesia, and anticholinergic drug use. Psychopharmacol Bull 18:83–86, 1982Google Scholar
  102. 102.
    Bosma JF, Geoffrey V, Thach B, Weiffenbach J, Kavanaugh T, Orr W: A pattern of medication-induced bulbar and cervical dystonia. Int J Orofacial Myol 8:5–19, 1982Google Scholar
  103. 103.
    Hughes CV, Baum BJ, Cox PC, Marmary Y, Yeh CK, Sonies BC: Oropharyngeal dysphagia: a common sequel of salivary gland dysfunction. Dysphagia 1:173–177, 1987Google Scholar
  104. 104.
    Ekberg O, Bergqvist D, Takolander R, Uddman R, Kitzing P: Pharyngeal function after carotid endarterectomy. Dysphagia 4:151–154, 1989Google Scholar
  105. 105.
    Buchholz DW, Jones, B, Ravich WJ: Dysphagia following anterior cervical fusion (Abstract) Presented to Dysphagia Research Society, 1992Google Scholar
  106. 106.
    Heitmiller RF, Jones B: Transient diminished airway protection following transhiatal esophagectomy. Am J Surg 162:422–446, 1991Google Scholar
  107. 107.
    Buchholz D, Barofsky I, Edwin D, Jones B, Ravich W: Psychogenic oropharyngeal dysphagia: report of 26 cases (Abstract) Presented to Dysphagia Research Society, 1993Google Scholar
  108. 108.
    Gray LP: The relationship of the ‘inferior constrictor swallow’ and ‘globus hystericus’ or the hypopharyngeal syndrome. J Laryngol Otol 97:607–618, 1983Google Scholar
  109. 109.
    Edwin D: Psychological aspects of dysphagia. Presented to Fourth Multidisciplinary Symposium on Dysphagia, 1992Google Scholar
  110. 110.
    Barofsky I: Intervention for psychogenic dysphagia. Presented to Fourth Multidisciplinary Symposium on Dysphagia, 1992Google Scholar
  111. 111.
    Edwin D: Psychiatric perspectives on swallowing disorders. Presented to Second International Multidisciplinary Symposium on Dysphagia, 1993Google Scholar
  112. 112.
    Pontoppidan H, Beecher HK: Progressive loss of protective reflexes in the airway with advance of age. JAMA 174:2209–2213, 1960Google Scholar
  113. 113.
    Ekbert O, Nylander G: Cineradiography of the pharyngeal stage of deglutition in 150 individuals without dysphagia. Br J Radiol 55:255–257, 1982Google Scholar
  114. 114.
    Baum BJ, Bodner L: Aging and oral motor function: evidence for altered performance among older persons. J Dent Res 62:2–6, 1983Google Scholar
  115. 115.
    Sonies BC, Tone M, Shawker T: Speech and swallowing in the elderly. Gerontology 3:115–123, 1984Google Scholar
  116. 116.
    Ekberg O, Wahlgren L: Pharyngeal dysfunctions and their interrelationship in patients with dysphagia. Acta Radiol 26:659–664, 1984Google Scholar
  117. 117.
    Borgstrom PS, Ekberg O: Pharyngeal dysfunction in the elderly. J Med Imaging 2:74–81, 1988Google Scholar
  118. 118.
    Borgstrom PS, Ekberg O: Speed of peristalsis in pharyngeal constrictor musculature: correlations to age. Dysphagia 2:140–144, 1988Google Scholar
  119. 119.
    Tracy JF, Logemann JA, Kahrilas PJ, Jacob P, Kobara M, Krugler C: Preliminary observations on the effects of age on oropharyngeal deglutition. Dysphagia 4:90–94, 1989Google Scholar
  120. 120.
    Logemann JA: Effects of aging on the swallowing mechanism. Otolaryngol Clin North Am 23:1045–1056, 1990Google Scholar
  121. 121.
    Ekberg O, Feinberg MJ: Altered swallowing function in elderly patients with dysphagia: radiographic findings in 56 patients. Am J Roentgenol 156:1181–1184, 1991Google Scholar
  122. 122.
    Robbins J, Hamilton JW, Lof GL, Kempster GB: Oropharyngeal swallowing in normal adults of different ages. Gastroenterology 103:823–829, 1992Google Scholar
  123. 123.
    Pitcher J: Dysphagia in the elderly: causes and diagnosis. Geriatrics 28:64–69, 1973Google Scholar
  124. 124.
    Sheth N, Diner WC: Swallowing problems in the elderly. Dysphagia 2:209–215, 1988Google Scholar
  125. 125.
    Feinberg MJ, Knebl JK, Tully J, Segall L: Aspiration and the elderly. Dysphagia 5:61–71, 1990Google Scholar
  126. 126.
    Feinberg MJ, Ekberg O: Videofluoroscopy in elderly patients with aspiration: importance of evaluating both oral and pharyngeal stages of deglutition. Am J Roentgenol 156:293–296, 1991Google Scholar
  127. 127.
    Donner MW, Jones B: Aging and neurological disease. In: Jones B, Donner MW (eds.) Normal and Abnormal Swallowing: Imaging in Diagnosis and Therapy. New York: Springer-Verlag, 1991Google Scholar
  128. 128.
    Feinberg MJ, Ekberg O, Segall L, Tully J: Deglutition in elderly patients with dementia: findings of videofluorographic evaluation and impact on staging and management. Radiology 183:811–814, 1992Google Scholar
  129. 129.
    Castell DO, Donner MW: Evaluation of dysphagia: a careful history is crucial. Dysphagia 2:65–71, 1987Google Scholar
  130. 130.
    Buchholz D: Neurologic evaluation of dysphagia. Dysphagia 1:187–192, 1987Google Scholar
  131. 131.
    Buchholz DW, Marsh BR: Multifactorial dysphagia: looking for a second, treatable cause. Dysphagia 1:88–90, 1986Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1994

Authors and Affiliations

  • David W. Buchholz
    • 1
    • 2
    • 3
  1. 1.The Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Neurological Consultation ClinicThe Johns Hopkins Outpatient CenterBaltimoreUSA
  3. 3.The Johns Hopkins Swallowing CenterBaltimoreUSA

Personalised recommendations