Acta Neurochirurgica

, Volume 159, Issue 6, pp 1005–1011

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

  • Kwang Wook Jo
  • Youngkook Kim
  • Geun-Young Park
  • Ik Seong Park
  • Yongjun Jang
  • Sohn Dong Gyun
  • Sun Im
Case Report - Functional
  • 143 Downloads

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.

Keywords

Hydrocephalus Diffusion tensor imaging Deglutition disorders Corticobulbar tract 

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

References

  1. 1.
    Assaf Y, Ben-Sira L, Constantini S, Chang LC, Beni-Adani L (2006) Diffusion tensor imaging in hydrocephalus: initial experience. AJNR Am J Neuroradiol 27:1717–1724PubMedGoogle Scholar
  2. 2.
    Bradley WG Jr (2016) Magnetic resonance imaging of normal pressure hydrocephalus. Semin Ultrasound CT MR 37:120–128CrossRefPubMedGoogle Scholar
  3. 3.
    Chankaew E, Srirabheebhat P, Manochiopinig S, Witthiwej T, Benjamin I (2016) Bulbar dysfunction in normal pressure hydrocephalus: a prospective study. Neurosurg Focus 41, E15CrossRefPubMedGoogle Scholar
  4. 4.
    Crary MA, Mann GD, Groher ME (2005) Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil 86:1516–1520CrossRefPubMedGoogle Scholar
  5. 5.
    Daniels SK, Corey DM, Fraychinaud A, DePolo A, Foundas AL (2006) Swallowing lateralization: the effects of modified dual-task interference. Dysphagia 21:21–27CrossRefPubMedGoogle Scholar
  6. 6.
    Ertekin C, Aydogdu I, Tarlaci S, Turman AB, Kiylioglu N (2000) Mechanisms of dysphagia in suprabulbar palsy with lacunar infarct. Stroke 31:1370–1376CrossRefPubMedGoogle Scholar
  7. 7.
    Finney GR (2009) Normal pressure hydrocephalus. Int Rev Neurobiol 84:263–281CrossRefPubMedGoogle Scholar
  8. 8.
    Hamdy S, Aziz Q, Rothwell JC, Crone R, Hughes D, Tallis RC, Thompson DG (1997) Explaining oropharyngeal dysphagia after unilateral hemispheric stroke. Lancet 350:686–692CrossRefPubMedGoogle Scholar
  9. 9.
    Han TR, Paik NJ, Park JW (2001) Quantifying swallowing function after stroke: a functional dysphagia scale based on videofluoroscopic studies. Arch Phys Med Rehabil 82:677–682CrossRefPubMedGoogle Scholar
  10. 10.
    Hattori T, Ito K, Aoki S, Yuasa T, Sato R, Ishikawa M, Sawaura H, Hori M, Mizusawa H (2012) White matter alteration in idiopathic normal pressure hydrocephalus: tract-based spatial statistics study. AJNR Am J Neuroradiol 33:97–103CrossRefPubMedGoogle Scholar
  11. 11.
    Jang SH, Lee J, Kwon HG (2016) Reorganization of the corticobublar tract in a patient with bilateral middle cerebral artery territory infarct. Am J Phys Med Rehabil 95:e58–e59CrossRefPubMedGoogle Scholar
  12. 12.
    Jang SH, Lee J, Seo JP (2015) Pseudobulbar palsy due to bilateral injuries of corticobulbar tracts in a stroke patient. Int J Stroke 10:E53–E54CrossRefPubMedGoogle Scholar
  13. 13.
    Jang SH, Seo JP (2015) The anatomical location of the corticobulbar tract at the corona radiata in the human brain: diffusion tensor tractography study. Neurosci Lett 590:80–83CrossRefPubMedGoogle Scholar
  14. 14.
    Jang SH, Shin SM (2016) The usefulness of diffusion tensor tractography for estimating the state of corticobulbar tract in stroke patients. Clin Neurophysiol 127:2708–2709CrossRefPubMedGoogle Scholar
  15. 15.
    Jenabi M, Peck KK, Young RJ, Brennan N, Holodny AI (2015) Identification of the corticobulbar tracts of the tongue and face using deterministic and probabilistic DTI fiber tracking in patients with brain tumor. AJNR Am J Neuroradiol 36:2036–2041CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kwon HG, Lee J, Jang SH (2016) Injury of the corticobulbar tract in patients with dysarthria following cerebral infarct: diffusion tensor tractography study. Int J Neurosci 126:361–365CrossRefPubMedGoogle Scholar
  17. 17.
    Liegeois F, Tournier JD, Pigdon L, Connelly A, Morgan AT (2013) Corticobulbar tract changes as predictors of dysarthria in childhood brain injury. Neurology 80:926–932CrossRefPubMedGoogle Scholar
  18. 18.
    Liegeois FJ, Butler J, Morgan AT, Clayden JD, Clark CA (2016) Anatomy and lateralization of the human corticobulbar tracts: an fMRI-guided tractography study. Brain Struct Funct 221:3337–3345CrossRefPubMedGoogle Scholar
  19. 19.
    Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J (2008) MBS measurement tool for swallow impairment--MBSImp: establishing a standard. Dysphagia 23:392–405CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Nicot B, Bouzerar R, Gondry-Jouet C, Capel C, Peltier J, Fichten A, Baledent O (2014) Effect of surgery on periventricular white matter in normal pressure hydrocephalus patients: comparison of two methods of DTI analysis. Acta Radiol 55:614–621CrossRefPubMedGoogle Scholar
  21. 21.
    Pan C, Peck KK, Young RJ, Holodny AI (2012) Somatotopic organization of motor pathways in the internal capsule: a probabilistic diffusion tractography study. AJNR Am J Neuroradiol 33:1274–1280CrossRefPubMedGoogle Scholar
  22. 22.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL (1996) A penetration-aspiration scale. Dysphagia 11:93–98CrossRefPubMedGoogle Scholar
  23. 23.
    Scheel M, Diekhoff T, Sprung C, Hoffmann KT (2012) Diffusion tensor imaging in hydrocephalus—findings before and after shunt surgery. Acta Neurochir (Wien) 154:1699–1706CrossRefGoogle Scholar
  24. 24.
    Siasios I, Kapsalaki EZ, Fountas KN, Fotiadou A, Dorsch A, Vakharia K, Pollina J, Dimopoulos V (2016) The role of diffusion tensor imaging and fractional anisotropy in the evaluation of patients with idiopathic normal pressure hydrocephalus: a literature review. Neurosurg Focus 41, E12CrossRefPubMedGoogle Scholar
  25. 25.
    Smith SM, Jenkinson M, Woolrich MW, Beckmann CF, Behrens TE, Johansen-Berg H, Bannister PR, De Luca M, Drobnjak I, Flitney DE, Niazy RK, Saunders J, Vickers J, Zhang Y, De Stefano N, Brady JM, Matthews PM (2004) Advances in functional and structural MR image analysis and implementation as FSL. NeuroImage 23(Suppl 1):S208–S219CrossRefPubMedGoogle Scholar
  26. 26.
    Teismann IK, Dziewas R, Steinstraeter O, Pantev C (2009) Time-dependent hemispheric shift of the cortical control of volitional swallowing. Hum Brain Mapp 30:92–100CrossRefPubMedGoogle Scholar
  27. 27.
    Toma AK, Holl E, Kitchen ND, Watkins LD (2011) Evans’ index revisited: the need for an alternative in normal pressure hydrocephalus. Neurosurgery 68:939–944CrossRefPubMedGoogle Scholar
  28. 28.
    Urban PP, Hopf HC, Fleischer S, Zorowka PG, Muller-Forell W (1997) Impaired cortico-bulbar tract function in dysarthria due to hemispheric stroke. Functional testing using transcranial magnetic stimulation. Brain 120(Pt 6):1077–1084CrossRefPubMedGoogle Scholar
  29. 29.
    Wang C, Du HG, Yin LC, He M, Zhang GJ, Tian Y, Hao BL (2013) Analysis of related factors affecting prognosis of shunt surgery in patients with secondary normal pressure hydrocephalus. Chin J Traumatol 16:221–224PubMedGoogle Scholar
  30. 30.
    Yim SH, Kim JH, Han ZA, Jeon S, Cho JH, Kim GS, Choi SA, Lee JH (2013) Distribution of the corticobulbar tract in the internal capsule. J Neurol Sci 334:63–68CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  1. 1.Department of Neurosurgery, Bucheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaBucheon-siSouth Korea
  2. 2.Department of Rehabilitation MedicineRHIIN HospitalPoeunDeroSouth Korea
  3. 3.Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaBucheon-siSouth Korea

Personalised recommendations