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Gomez JE, Ho EJ. A diagnosis that's hard to swallow: case report of delayed onset lateral medullary syndrome presenting with only dysphagia. Int J Emerg Med 2024; 17:144. [PMID: 39375579 PMCID: PMC11459998 DOI: 10.1186/s12245-024-00709-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 09/11/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Lateral Medullary Syndrome (LMS) is a posterior circulation stroke (PCS) that has a broad array of manifestations but most classically presents with Horner's syndrome, ipsilateral ataxia, and ipsilateral hyperalgesia. Although dysphagia is also common, isolated and single presentation of this alone is rare and there are only a few case reports of this in the literature. This presentation can bias a clinician's differential diagnosis and delay diagnosis. CASE PRESENTATION A previously healthy 53-year-old-male presented with a complaint of dysphagia. He had no PCS symptoms, a National Institute of Health Stroke Scale (NIHSS) of zero, and an otherwise unremarkable neurological exam. Stroke imaging including non-contrast computed tomography (NCCT) scan of his head and computed tomography angiography (CTA) scan of his head and neck revealed no acute abnormalities. He was found to be positive for Influenza A, but otherwise all other etiologies for his dysphagia were worked up, including consultation with other specialty services, without resolve. Two days later, the patient subsequently developed new right sided sensory deficits and left sided Horner's syndrome, in which a magnetic resonance imaging (MRI) scan of his head revealed an acute infarct of the left lateral medulla with likely thrombus in the left posterior inferior cerebellar artery (PICA). CONCLUSIONS PCS is frequently missed due to the often-vague symptoms and reassuring negative imaging. This case highlights the variability of presentations that ED physicians may encounter. Nonetheless, a high index of suspicion for PCS should be maintained even in young patients without risk factors. Lastly, dysphagia is never normal, and this case demonstrates the need to reconsider neurogenic origin when other causes have been ruled out.
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Affiliation(s)
- Jose Ernesto Gomez
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Eric Justin Ho
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
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Taniguchi K, Tsutsumiuchi K, Sagara Y, Tayama N. Outcome of Surgery to Improve Swallowing in Patients with Lateral Medullary Syndrome: A Retrospective Cohort Study. Dysphagia 2024; 39:948-955. [PMID: 38441622 DOI: 10.1007/s00455-024-10675-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 01/22/2024] [Indexed: 10/04/2024]
Abstract
The study investigated surgical interventions to improve dysphagia in patients with lateral medullary syndrome (LMS), along with optimal scheduling of surgery and prognostic factors. In this retrospective, single-center cohort study, dysphagia patients with LMS who underwent surgery between January 2010 and December 2021 were enrolled. The National Outcomes Measurement System (NOMS) was used to classify swallowing function (level 1: only tube feeding, level 5: without tube feeding). Patients were divided into four groups. Groups 1 and 2, LMS onset within 1 year, and groups 3 and 4, onset after 1 year. Groups 1 and 3 had infarctions confined to the oblongata. Groups 2 and 4 had infarctions extending to the cerebellum. The primary outcome was the time to achieve NOMS ≥ 5. The final NOMS level and pathological findings were considered. Nineteen cases were included. Group 4 comprised one case and was excluded. The mean overall preoperative NOMS was 1.11. The mean time to NOMS ≥ 5 was 9.6 months (95% confidence interval: 5.04-14.2), and that to NOMS ≥ 5 was 1.67 (1.07-2.26), 11.4 (4.71-18.1), and 7.6 (5.15-10.1) months for groups 1, 2, and 3, respectively. Group 1 achieved NOMS ≥ 5 earlier than groups 2 and 3 (P = 0.01 and 0.03, respectively). The overall final NOMS value was 4.68. Fourteen patients had atrophy or fibrosis of the cricopharyngeal muscle. In conclusion, surgery was effective for effective for treating dysphagia in LMS patients. However, improvement is prolonged if > 1 year has passed since onset or the infarction extended to the cerebellum.
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Affiliation(s)
- Kenshiro Taniguchi
- Department of Otolaryngology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan.
| | - Katsuhiro Tsutsumiuchi
- Department of Otolaryngology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - Yukiko Sagara
- Department of Otolaryngology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - Niro Tayama
- Department of Otolaryngology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
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Kunieda K, Suzuki S, Naganuma S, Okamoto K, Ohno T, Shigematsu T, Yagi N, Oku Y, Fujishima I. Efficacy and Safety of "Vacuum Swallowing" Based on a Strong Negative Esophageal Pressure in Healthy Individuals. Dysphagia 2024:10.1007/s00455-024-10741-y. [PMID: 39153047 DOI: 10.1007/s00455-024-10741-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/27/2024] [Indexed: 08/19/2024]
Abstract
Vacuum swallowing is a unique method for improving the pharyngeal passage of a bolus by creating subatmospheric negative pressure in the esophagus. However, whether healthy individuals and other patients with dysphagia can reproduce vacuum swallowing remains unclear. Therefore, this study aimed to assess whether healthy individuals verified using high-resolution manometry (HRM) could reproduce vacuum swallowing and evaluate its safety using a swallowing and breathing monitoring system (SBMS). Two healthy individuals who mastered vacuum swallowing taught this method to 12 healthy individuals, who performed normal and vacuum swallowing with 5 mL of water five times each. The minimum esophageal pressure and the maximum pressure of the lower esophageal sphincter (LES) were evaluated during each swallow using the HRM. Additionally, respiratory-swallowing coordination was evaluated using the SBMS. Ten individuals reproduced vacuum swallowing, and a total of 50 vacuum swallows were analyzed. The minimum esophageal pressure (-15.0 ± 4.9 vs. -46.6 ± 16.7 mmHg; P < 0.001) was significantly lower, and the maximum pressure of the LES (25.4 ± 37.7 vs. 159.5 ± 83.6 mmHg; P < 0.001) was significantly higher during vacuum swallowing. The frequencies of the I-SW and SW-I patterns in vacuum swallowing were 38.9% and 0%, respectively, using the SBMS. Vacuum swallowing could be reproduced safely in healthy participants with instruction. Therefore, instructing exhalation before and after vacuum swallowing is recommended to prevent aspiration.
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Affiliation(s)
- Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan.
| | - Saori Suzuki
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Satoe Naganuma
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Keishi Okamoto
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
| | - Naomi Yagi
- Advanced Medical Engineering Research Institute, University of Hyogo, Himeji, Hyogo, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Shizuoka, Japan
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Khalil MT, Rathore FA. Letter to the Editor on "The Influence of Hemoglobin and Swallowing Ability on Daily Living Activities After Hospital Discharge in Taiwanese Stroke Patients: A Longitudinal Study". Arch Phys Med Rehabil 2024; 105:1407-1408. [PMID: 38570180 DOI: 10.1016/j.apmr.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 04/05/2024]
Affiliation(s)
- Muhammad Tawab Khalil
- Armed Forces Institute of Rehabilitation Medicine (AFIRM), Convoy Road, Rawalpindi, Pakistan.
| | - Farooq Azam Rathore
- Armed Forces Institute of Rehabilitation Medicine (AFIRM), Convoy Road, Rawalpindi, Pakistan
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Li K, Fu C, Xie Z, Zhang J, Zhang C, Li R, Gao C, Wang J, Xue C, Zhang Y, Deng W. The impact of physical therapy on dysphagia in neurological diseases: a review. Front Hum Neurosci 2024; 18:1404398. [PMID: 38903410 PMCID: PMC11187312 DOI: 10.3389/fnhum.2024.1404398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
A neurogenic dysphagia is dysphagia caused by problems with the central and peripheral nervous systems, is particularly prevalent in conditions such as Parkinson's disease and stroke. It significantly impacts the quality of life for affected individuals and causes additional burdens, such as malnutrition, aspiration pneumonia, asphyxia, or even death from choking due to improper eating. Physical therapy offers a non-invasive treatment with high efficacy and low cost. Evidence supporting the use of physical therapy in dysphagia treatment is increasing, including techniques such as neuromuscular electrical stimulation, sensory stimulation, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation. While initial studies have shown promising results, the effectiveness of specific treatment regimens still requires further validation. At present, there is a lack of scientific evidence to guide patient selection, develop appropriate treatment regimens, and accurately evaluate treatment outcomes. Therefore, the primary objectives of this review are to review the results of existing research, summarize the application of physical therapy in dysphagia management, we also discussed the mechanisms and treatments of physical therapy for neurogenic dysphagia.
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Affiliation(s)
- Kun Li
- Shandong Daizhuang Hospital, Jining, China
| | - Cuiyuan Fu
- Shandong Daizhuang Hospital, Jining, China
| | - Zhen Xie
- Shandong Daizhuang Hospital, Jining, China
| | - Jiajia Zhang
- Department of Psychology, Xinxiang Medical University, Xinxiang, China
| | | | - Rui Li
- Shandong Daizhuang Hospital, Jining, China
| | | | | | - Chuang Xue
- Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Wei Deng
- Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-Machine Intelligence, Zhejiang University, Hangzhou, China
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Furuya Y, Hirose G, Hokari T, Hirose K. Two Cases Diagnosed With Wallenberg Syndrome After Developing Dysphagia Following COVID-19 Infection. Cureus 2024; 16:e63065. [PMID: 39055404 PMCID: PMC11269102 DOI: 10.7759/cureus.63065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
We experienced two consecutive cases of Wallenberg syndrome that developed after COVID-19 infection. Case 1 had symptoms such as a sore throat, but also complained of strong stress related to work and home at the same time. Therefore, it was initially thought due to a mental cause, but the psychiatrist denied depression and pointed out that it was a physical problem. After conducting neurological examinations and a videofluoroscopic (VF) swallowing examination, it was found to be dysphagia. Based on these findings, Wallenberg syndrome was diagnosed by MRI. Due to these events, it took a very long time to diagnose. Because of this experience, Case 2 was diagnosed with Wallenberg syndrome in a short time. Therefore, if symptoms like those in this case report such as feeding problems are observed after COVID-19 infection, it is considered meaningful to suspect Wallenberg syndrome from the beginning.
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Affiliation(s)
- Yumi Furuya
- Rehabilitation Center, Hirose Hospital, Sagamihara, JPN
| | - Go Hirose
- Internal Medicine, Hirose Hospital, Sagamihara, JPN
| | - Takeo Hokari
- Internal Medicine, Hirose Hospital, Sagamihara, JPN
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Magara J, Ita R, Tsutsui Y, Sakai H, Zhang M, Inoue M. A Case of Dysphagia Rehabilitation in a Patient in the Chronic Stage of Lateral Medullary Syndrome. Dysphagia 2024; 39:534-539. [PMID: 38520512 DOI: 10.1007/s00455-024-10690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Jin Magara
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, 951-8520, Japan.
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8514, Japan.
| | - Reiko Ita
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8514, Japan
| | - Yuhei Tsutsui
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8514, Japan
| | - Haruka Sakai
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8514, Japan
| | - Mengjie Zhang
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8514, Japan
| | - Makoto Inoue
- Unit of Dysphagia Rehabilitation, Niigata University Medical & Dental Hospital, Niigata, 951-8520, Japan
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8514, Japan
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Okamoto K, Kunieda K, Ohno T, Ogawa M, Fujishima I. A Case of a Patient With Spinal Muscular Atrophy With Dysphagia Who Acquired Vacuum Swallowing. Cureus 2024; 16:e53129. [PMID: 38420075 PMCID: PMC10901426 DOI: 10.7759/cureus.53129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
We present a case of acquired vacuum swallowing in a patient with spinal muscular atrophy associated with dysphagia. A 67-year-old male presented with spinal muscular atrophy. Even though he was able to eat orally, he required a long time to eat and faced difficulty while swallowing saliva, resulting in frequent spitting. Instructions regarding vacuum swallowing to eliminate pharyngeal residue were provided, and a reduction in meal duration and improved saliva swallowing were observed. High-resolution manometry revealed a significant increase in pharyngeal contractile integral and a significant decrease in esophageal pressure with vacuum swallowing, which enabled the passage of a bolus through the pharynx compared with non-vacuum swallowing. Furthermore, an increase in the lower esophageal sphincter pressure, reflecting diaphragmatic contraction, was also observed. Therefore, this case report elucidates that a patient with neuromuscular disorders could acquire vacuum swallowing with proper instructions.
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Affiliation(s)
- Keishi Okamoto
- Rehabilitation, Hamamatsu City Rehabilitation Hospital, Shizuoka, JPN
| | - Kenjiro Kunieda
- Rehabilitation, Hamamatsu City Rehabilitation Hospital, Shizuoka, JPN
- Neurology, Gifu University Graduate School of Medicine, Gifu, JPN
| | - Tomohisa Ohno
- Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka, JPN
| | - Mika Ogawa
- Rehabilitation, Hamamatsu City Rehabilitation Hospital, Shizuoka, JPN
| | - Ichiro Fujishima
- Rehabilitation, Hamamatsu City Rehabilitation Hospital, Shizuoka, JPN
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Zhang N, Teng B, Lu X, Shi L, Liu L, Zhou F, Jiang N, Zhang X, Wang C, Shen S, Zheng R, Zhang S, Wang Y, Hu Y, Zhang B, Zhang Q, Wang L. Exploring the neural mechanisms underlying achalasia: A study of functional connectivity and regional brain activity. Neuroimage 2023; 284:120447. [PMID: 37949257 DOI: 10.1016/j.neuroimage.2023.120447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/09/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND AND AIMS The pathophysiology of achalasia, which involves central nuclei abnormalities, remains unknown. We investigated the resting-state functional MRI (rs-fMRI) features of patients with achalasia. METHODS We applied resting-state functional MRI (rs-fMRI) to investigate the brain features in patients with achalasia (n = 27), compared to healthy controls (n = 29). Focusing on three regions of interest (ROIs): the dorsal motor nucleus of the vagus (DMV), the nucleus ambiguus (NA), and the nucleus of the solitary tract (NTS), we analyzed variations in resting-state functional connectivity (rs-FC), fractional amplitude of low-frequency fluctuations (fALFF), and regional homogeneity (ReHo). RESULTS Achalasia patients demonstrated stronger functional connectivity between the NA and the right precentral gyrus, left postcentral gyrus, and left insula. No significant changes were found in the DMV or NTS. The fMRI analysis showed higher rs-FC values for NA-DMV and NA-NTS connections in achalasia patients. Achalasia patients exhibited decreased fALFF values in the NA, DMV, and NTS regions, as well as increased ReHo values in the NA and DMV regions. A positive correlation was observed between fALFF values in all six ROIs and the width of the barium meal. The NTS fALFF value and NA ReHo value displayed a positive correlation with integrated relaxation pressure (IRP), while the ReHo value in the right precentral gyrus showed an inverse correlation with the height of the barium meal. CONCLUSIONS Abnormal rs-FC and regional brain activity was found in patients with achalasia. Our study provides new insights into the pathophysiology of achalasia and highlights the potential of rs-fMRI in improving the diagnosis and treatment of this condition.
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Affiliation(s)
- Nina Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China; Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Binyu Teng
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinyi Lu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Liangliang Shi
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Li Liu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Fan Zhou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ni Jiang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xin Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Cong Wang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Shanshan Shen
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ruhua Zheng
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Shu Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yi Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yuzheng Hu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bing Zhang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Qipeng Zhang
- State Key Laboratory of Pharmaceutical Biotechnology, Institute for Brain Sciences, School of Life Sciences, Nanjing University, Nanjing, Jiangsu, China
| | - Lei Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
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Dodderi T, Muthukumar V, Hedge PS, Rai SPV, Moolambally SR, Balasubramanium RK, Kothari M. A Survey of Speech-Language Pathologists' Applications of Motor Learning Principles in Dysphagia Therapy in Adults in India. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3745-3762. [PMID: 37672783 DOI: 10.1044/2023_jslhr-23-00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PURPOSE In the study, we investigated whether speech-language pathologists (SLPs) in India use practice and feedback conditions of motor learning principles (MLPs), including biofeedback, in dysphagia therapy in adults using a problem-solution approach. METHOD Based on a literature review and clinical experience, we developed and validated a hypothetical case involving an adult with dysphagia (representing the problem) and a purpose-built 22-item questionnaire (representing the solution). We distributed the questionnaire electronically by sending an e-mail to 2,069 SLPs and also published a flyer on the dysphagia special interest group of India. RESULTS A total of 107 SLPs anonymously submitted their responses. In practice conditions, most of the SLPs reported following massed over distributed, small over large, blocked over random, whole over part, variable over constant, and internal over external practice strategies. In feedback conditions, most of the participants reported using knowledge of results over performance, high over low, immediate over delayed, and self over therapist feedback strategies. Lastly, more than two thirds of SLPs did not use biofeedback devices for dysphagia therapy. CONCLUSION The findings from our study indicate that SLPs in India do not adhere uniformly to the recommended practices of MLPs for dysphagia therapy in adults.
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Affiliation(s)
- Thejaswi Dodderi
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Varsha Muthukumar
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | | | - Santosh P V Rai
- Department of Radio Diagnosis and Imaging, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Sheetal Raj Moolambally
- Department of General Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Radish Kumar Balasubramanium
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Mohit Kothari
- Hammel Neurorehabilitation Center and University Research Clinic, Department of Clinical Medicine, Aarhus University, Denmark
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Shenoy S V, K K, Parvathareddy N, Dhawan S. Cricopharyngeal Myotomy; a Rescue Surgery for Dysphagia in Lateral Medullary Syndrome. Indian J Otolaryngol Head Neck Surg 2023; 75:988-990. [PMID: 37275090 PMCID: PMC10235379 DOI: 10.1007/s12070-022-03165-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/05/2022] [Indexed: 11/09/2022] Open
Abstract
Lateral medullary syndrome/Wallenberg syndrome, is a neurological disorder occurring due to ischemia in the lateral part of medullary oblongata resulting in wide range of symptoms. Dysphagia is usually exhibited in severe and persistent form in LMS. Hence timely intervention is mandatory before the patient further worsens. We describe a case of Lateral medullary syndrome with persisitent dysphagia who was managed successfully with cricopharyngeal myotomy.
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Affiliation(s)
- Vijendra Shenoy S
- Dept of ENT and Head & neck surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Kshithi K
- Dept of ENT and Head & neck surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Navya Parvathareddy
- Dept of ENT and Head & neck surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Saksham Dhawan
- Dept of ENT and Head & neck surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
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Roy P, Akpoigbe O, Akanmode AM, Anim-Koranteng C, Olusoji R. Food Stuck in the Throat in a Newly Diagnosed Diabetes Mellitus Patient: An Atypical Presentation of Wallenberg's Syndrome. Cureus 2023; 15:e38076. [PMID: 37234141 PMCID: PMC10208627 DOI: 10.7759/cureus.38076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Wallenberg's syndrome, also known as posterior inferior cerebellar artery syndrome (lateral medullary syndrome), is known to be a common cause of posterior ischemic stroke syndromes in men in their 60s and may present with varied symptoms devoid of focal neurological signs making it easily missed as a differential of posterior ischemic strokes. It involves a stroke in the vertebral or posterior inferior cerebellar artery of the brainstem. In this case report, we critically examine the case of a 66-year-old man with newly diagnosed diabetes whose main presentation was dysphagia and unsteady gait. There was no motor or sensory examination finding in our patient, and the initial computed tomography of the brain was negative for any intracranial pathology leading to very low suspicion of stroke. However, given a high index of suspicion and a thorough oropharyngeal examination ruling out structural abnormality, magnetic resonance imaging of the brain revealed features suggestive of Wallenberg's syndrome. This case emphasizes careful consideration of posterior stroke syndrome when evaluating patients presenting with dysphagia without typical motor/sensory symptoms of cerebrovascular accident and the requirement of further imaging to support the diagnosis.
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Affiliation(s)
- Pooja Roy
- Internal Medicine, Harlem Hospital Center, New York, USA
| | | | | | | | - Rahman Olusoji
- Internal Medicine, Harlem Hospital Center, New York, USA
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13
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Ali F, Zubair A, Nazir F, Ali K, Mansoor S. Acute dysphagia: A rare initial symptom of lateral medullary syndrome: A case report. Ann Med Surg (Lond) 2022; 84:104851. [PMID: 36582892 PMCID: PMC9793181 DOI: 10.1016/j.amsu.2022.104851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction and importance A unique etiology of stroke, lateral medullary syndrome (LMS), is a consequence of posterior inferior cerebellar artery or vertebral artery thromboembolic conditions. LMS patients present particularly with ipsilateral hyperalgesia, ipsilateral ataxia, and Horner's syndrome. Our case signifies that neurogenic origin should always be considered in the absence of local causes of dysphagia. Early diagnosis could prevent LMS complications, including neurological disabilities. A scarcity of research related to dysphagia in LMS, and its outcomes exists. Therefore, the objective is to investigate the clinical course in a patient afflicted with severe dysphagia following a diagnosis of (LMS). This would encourage further research, thus improving management and treatment strategies. Case presentation We report a case of a 45-year-old male, a smoker for 20 years, who presented with a single, unique complaint of acute dysphagia for 9 days. According to our knowledge, this is among very few reported cases of LMS with dysphagia being the rare initial complaint. The neurological issues associated with dysphagia gradually improved with the administration of antiplatelet; clopidogrel and lipid-lowering drug; rosuvastatin and the patient was discharged. Atypical presentation in LMS could be supported by the presence of lateral medullary infarct which was confirmed by MRI (Magnetic Resonance Imaging). Clinical discussion Dysphagia is a common complaint in multiple gastrointestinal (GI) settings. However, in cases where the GI causes are excluded, as described here, diagnosis of LMS becomes tough. Conclusion The diagnosis of LMS was queried owing to the presentation of the single most important common symptom, with no other characteristic manifestations of LMS.
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Affiliation(s)
- Farhan Ali
- Department of Internal Medicine, Chandka Medical College Hospital, Shah Nawaz Bhutto road, Larkana city, Sindh, 77170, Pakistan
| | - Amraha Zubair
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Mission Rd, Nanak Wara Nanakwara, Karachi City, Sindh, 74200, Pakistan,Corresponding author.
| | - Fatima Nazir
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Mission Rd, Nanak Wara Nanakwara, Karachi City, Sindh, 74200, Pakistan
| | - Kashif Ali
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Mission Rd, Nanak Wara Nanakwara, Karachi City, Sindh, 74200, Pakistan
| | - Sobia Mansoor
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Mission Rd, Nanak Wara Nanakwara, Karachi City, Sindh, 74200, Pakistan
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Kunieda K, Sugiyama J, Nomoto A, Ohno T, Shigematsu T, Fujishima I. Compensatory swallowing methods in a patient with dysphagia due to lateral medullary syndrome-vacuum and prolonged swallowing: A case report. Medicine (Baltimore) 2022; 101:e28524. [PMID: 35029918 PMCID: PMC8735762 DOI: 10.1097/md.0000000000028524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The nature of pharyngeal swallowing function during the course of recovery of dysphagia due to lateral medullary syndrome (LMS) is unclear. Vacuum swallowing is a compensatory swallowing method that improves the pharyngeal passage of a bolus by creating negative pressure during swallowing in the esophagus in patients with dysphagia due to LMS. We present a case involving a patient with dysphagia due to LMS who involuntarily acquired a swallowing method with prolonged and increased pharyngeal contraction and vacuum swallowing. PATIENT CONCERNS We report a unique case involving a 52-year-old patient with dysphagia due to LMS. His dysphagia was severe but improved gradually with swallowing rehabilitation. The patient involuntarily acquired a swallowing method with prolonged and increased pharyngeal contraction and vacuum swallowing. DIAGNOSIS The patient presented with dysphagia due to left LMS. A videofluoroscopic examination of swallowing revealed pharyngeal residue. INTERVENTIONS Forty-five days after the onset of the dysphagia, the swallowing pressure along the pharynx and esophagus was measured using high-resolution manometry. OUTCOMES Vacuum swallowing was observed in six out of 19 swallows (32.5%). The velopharyngeal contractile integral (CI) and mesohypopharyngeal CI values increased during swallowing, reflecting prolonged and increased pharyngeal contraction. We named this swallowing method "prolonged swallowing." CONCLUSION The findings in this case indicate that vacuum and prolonged swallowing may be compensatory swallowing methods observed in individuals recovering from dysphagia due to LMS. Further research is needed to clarify the relationship between these swallowing methods and the pathophysiology, prognosis, and treatment of dysphagia in patients with LMS.
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Affiliation(s)
- Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Junya Sugiyama
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
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Kunieda K, Sugi T, Ohno T, Nomoto A, Shigematsu T, Kanazawa H, Fujishima I. Incoordination during the pharyngeal phase in severe dysphagia due to lateral medullary syndrome. Clin Case Rep 2021; 9:1728-1731. [PMID: 33768924 PMCID: PMC7981674 DOI: 10.1002/ccr3.3890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/25/2020] [Accepted: 01/21/2021] [Indexed: 12/02/2022] Open
Abstract
One of the mechanisms of severe dysphagia due to lateral medullary syndrome may be a reversed pressure gradient caused by incoordination of pharyngeal contractility and UES opening during swallowing.
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Affiliation(s)
- Kenjiro Kunieda
- Department of NeurologyGifu University Graduate School of MedicineGifuJapan
- Department of Rehabilitation MedicineHamamatsu City Rehabilitation HospitalHamamatsuJapan
| | - Takafumi Sugi
- Department of Rehabilitation MedicineHamamatsu City Rehabilitation HospitalHamamatsuJapan
| | - Tomohisa Ohno
- Department of DentistryHamamatsu City Rehabilitation HospitalHamamatsuJapan
| | - Akiko Nomoto
- Department of DentistryHamamatsu City Rehabilitation HospitalHamamatsuJapan
| | - Takashi Shigematsu
- Department of Rehabilitation MedicineHamamatsu City Rehabilitation HospitalHamamatsuJapan
| | - Hideaki Kanazawa
- Department of Rehabilitation MedicineHamamatsu City Rehabilitation HospitalHamamatsuJapan
| | - Ichiro Fujishima
- Department of Rehabilitation MedicineHamamatsu City Rehabilitation HospitalHamamatsuJapan
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