Rinsho Shinkeigaku (Clinical Neurology)

Symposium 22

Dysphagia with lateral medullary infarction (Wallenberg's syndrome)

Fumiko Oshima, M.D.

Department of Neurology, Japanese Red Cross Kyoto Daiichi Hospital

Dysphagia after lateral medullary infarction (LMI) is common. The dysphagia of LMI is dynamically characterized by a failure in triggering of the pharyngeal-phase swallowing movements, reduced output, and lack of coordination (swallowing pattern abnormality). Based on accurate evaluation, we can select suitable rehabilitative approaches for individual patients, including respiratory therapy, food modification, postural changes, and oral care. We focused on the absence of upper esophageal sphincter (UES) opening of the unaffected side of the medullae. The movement pattern was defined as failure of bolus passage through the intact side of the UES, occurring at least once during the videofluorographic evaluation of each individual. Three abnormal patterns of UES opening were classified. The passage pattern abnormality shows the failure of the stereotyped motor sequence. For severe cases, it is necessary to consider long-term treatment, including botulinum toxin injection or surgery to prevent aspiration and adequate nutritional management.
Full Text of this Article in Japanese PDF (199K)

(CLINICA NEUROL, 51: 1069|1071, 2011)
key words: dysphagia, lateral medullary infarction, Wallenberg syndrome, passage pattern abnormality, upper esophageal sphincter opening

(Received: 20-May-11)