＜シンポジウム22―2＞難治性嚥下障害に対する治療戦略
延髄外側梗塞（Wallenberg症候群）による嚥下障害
巨島 文子
京都第一赤十字病院神経内科〔〒605―0981 京都市東山区本町15―749〕
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)
(臨床神経, 51：1069−1071, 2011)
key words：嚥下障害，延髄外側梗塞，Wallenberg症候群，食道入口部開大，食道入口部通過異常
（受付日：2011年5月20日）
