Dysphagia in Lateral Medullary Infarction (Wallenberg’s Syndrome)

Abstract

Background and Purpose-We have investigated the pathophysiological mechanisms of dysphagia in Wallenberg's syndrome (WS) that are due to lateral medullary infarction (LMI). Methods-Twenty patients with WS were evaluated by means of clinical and electrophysiological methods that measured the oropharyngeal phase of voluntarily initiated swallowing. For comparison, 22 patients with unilateral hemispheric infarction were investigated during the acute stage of stroke, and 4 patients with unilateral peripheral 9th and 10th cranial nerve palsies were studied. Age-matched 30 healthy control subjects were also included in the study. Results-It was found that dysphagia was clinically more severe in WS patients than in the patients in the other groups.The pharyngeal phase of swallowing was predominantly impaired, whereas in patients with hemispheric stroke, dysphagia was related only to the delay of triggering of the voluntarily induced swallowing. In WS patients, the swallowing reflex was extremely slow in spite of the unilateral involvement due to LMI, whereas the pharyngeal phase of reflex swallowing remained within normal limits in patients with unilateral hemispheric stroke and patients with unilateral peripheral 9th and 10th cranial nerve palsies. Conclusions-Although in WS the lesion due to LMI is unilateral, its effect on oropharyngeal swallowing is bilateral. In LMI, primarily the premotor neurons in the nucleus ambiguus and their connections seem to be affected. Consequently, a disruption and/or disconnection of their linkage to swallowing-related cranial motor neuron pools bilaterally and to the contralateral nucleus ambiguus could produce the swallowing disorders in WS. However, the remaining intact ipsilateral premotor neurons and the contralateral center in the medulla oblongata may eventually begin to operate and overcome the severity and long-term persistence of dysphagia.

The Role of Electrophysiologic Evaluation in Dysphagia Diagnosis in Acute Stroke Patients

“…Despite the lack of a study in the literature that we can directly make a comparison to, the results of this study is in support with 2 reports previously published. The results of 0-2 interval durations of the present study contradict to that of Aydogdu et al [14]. However, it is important to note that in that a for mentioned study only patients with MCA infarcts were included.…”

“…In another study conducted by Aydogdu et al [14], the swallowing intervals and dysphagia limits were evaluated in one sided hemispheric infarct patients (2-75 days after stroke). The patient group had significantly longer A-0 and A-C intervals, while no difference was detected with respect to 0-2 intervals.…”

“…In the studies on various neurological diseases, it was shown that the usage of this method took shorter time, was easier, less invasive, cheaper and with higher patient tolerability, comparing to video fluoroscopy, endoscopy and manometric evaluations [9,12,13]. Whilst there are very few studies made in stroke patients [9,14,15], there is not any study made only on acute period stroke patients.…”

Normal Swallowing and Functional Magnetic Resonance Imaging: A Systematic Review

“…These investigations have characteristically started with a disordered neurologic group (i.e., poststroke population) and combined both anatomical brain-imaging techniques (still pictures of the brain) such as computerized tomography (CT) and/or magnetic resonance imaging (MRI) with a swallowing assessment to correlate damaged brain areas with the presence or type of dysphagia observed. The vast majority of clinical studies have focused on the effects of stroke on swallowing [2][3][4][5][6][7][8][9][10][11][12][13][14][15] This systematic review summarizes studies that have explored the neurophysiology of swallowing in healthy adults using fMRI. The goal of a systematic review is to gather and present objectively the current status of research in a particular area of interest.…”

Disfagia orofaríngea na Síndrome de Wallenberg - série de casos

“…Thus, lesions in these cranial nerves interfere with the swallowing process, they can cause uncontrollable sobs; ipsilateral paralysis to the lesion, palate and vocal cords; ipsilateral facial hypalgesia and possible loss of taste in hemi-tongue 8,9 . OD after WS is frequently classified as a severe degree, affecting the pharyngeal phase of swallowing, and the prognosis depends on the extent and location of the lesion, which may vary from complete recovery to a permanent vegetative basis [10][11][12][13][14] . Furthermore, patients with neurogenic OD might present other neurological symptoms and deficits in cognitive abilities due to injury in areas of the central nervous system, which may complicate the clinical condition 15 .…”