Dysphagia in Lateral Medullary Syndrome
Keywords:
lateral medullary syndrome, dysphagia, diagnosis, treatment
Abstract
The lateral medullary syndrome is a neurological disease caused by ischemia in the lateral part of the medulla oblongata and is the most common form of brainstem infarction. Dysphagia is a common and clinically significant symptom of this disease because it is closely associated with the risk of recurrent pneumonia, malnutrition, dehydration, and an increase in mortality and prolonged hospital treatment. This paper aims to review and analyze data on the correlation between swallowing disorders and lateral medullary syndrome. We intend to present the symptoms, diagnostic and therapeutic procedures of dysphagia in patients with this syndrome in a comprehensive way. The following databases were used to search the literature: KoBSON-Consortium of Serbian Libraries for Unified Procurement, PubMed, Science Direct. Based on the results of the reviewed studies, it was determined that patients with the lateral medullary syndrome often have swallowing disorders. They are often fed through a nasogastric tube and a few months after stroke, which significantly impairs their quality of life. To overcome swallowing disorders and create conditions for safe swallowing function, most patients need treatment for a longer period. In addition to the available screening tests, instrumental diagnostic methods provide insight into the biomechanical aspects of swallowing disorders, determine the risk of aspiration, and provide a starting point for selecting treatment strategies. Treatment depends on the mechanisms of occurrence and the predictors of recovery of swallowing function. When conducting treatment, among other things, it is important to know the pathological mechanisms of neural connections of the medulla oblongata.
References
LITERATURE
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2- Pavlović S, Stefanović N, Vučetić R, Antić S, Čukuranović R, Arsić S. Anatomija centralnog nervnog sistema i čula. Niš: Sven; 2006.
3- Bian R, Choi I, Kim J, Han J, Lee S. Impaired Opening of the Upper Esophageal Sphincter in Patients with Medullary Infarctions. Dysphagia. 2008;24(2):238-245.
4- Sacco R, Freddo L, Bello A, Odel G, Onesti T, Mohr P. Wallenbergs lateral medullary syndrome. Clinical magnetic resonance imaging correlation. Archives of neurology. 1993; 50 (6):609-614
5- Daniels S. Neurological disorders affecting oral, pharyngeal swallowing. GI Motility. 2006.
6- Vuković M. Poremećaji komunikacije kod traumatskih oštećenja mozga. Beograd: Univerzitet u Beogradu – Fakultet za specijalnu edukaciju i rehabilitaciju; 2012.
7- Saitoh E, Pongpipatbaiboon K, Inamoto Y, Kagaya H. Dysphagia Evaluation and Treatment. Singapore: Springer; 2018.
8- Logemann J. Evaluation and Treatment of Swallowing Disorders. Austin: Pro-ed; 1998.
9- Matsuo K, Palmer J. Anatomy and Physiology of Feeding and Swallowing - Normal and Abnormal. Physical Medicine and Rehabilitation Clinics of North America, 2008 Nov;19(4):691-707
10- Jiang E, Lyu Q, Lin F, You T, Jiang L. Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome: Two case reports. World Journal of Clinical Cases, 2020 Mart; 8(6):1142-1149
11- Miller J. Characteristics of the swallowing reflex induced by peripheral nerve and brainstem stimulation. Experimental Neurology, 1972; 34 (2):210-222.
12- Bautista G, Dutschmann M. Pontomedullary nuclei involved in the generation of sequential pharyngeal swallowing and concomitant protective laryngeal adduction in situ. Journal of Physiology, 2014 Jun; 592 (12):2605-2623.
13- Harris Warrick M. General principles of rhythmogenesis in central pattern generator networks. Progress in brain research, 2010; 187: 213-222.
14- Morquette P, Lavoie R, Fhima D, Lamoureux X, Verdier D, Kolta A. Generation of the masticatory central pattern and its modulation by sensory feedback. Progress in Neurobiology, 2012 Mart; 96(3):340-355.
15- Guertin A, Steuer I. Key central pattern generators of the spinal cord. Journal of Neuroscience Research, 2009: 87 (11): 2399-2405.
16- Abdala P, Rybak A, Smith C, Zoccal B, Machado H, St-John M, Paton F. Multiple pontomedullary mechanisms of respiratory rhythmogenesis. Respiratory Physiology & Neurobiology, 2009; 168:19-25.
17- Jean A. Brainstem control of swallowing: Neuronal network and cellular mechanisms. Physiological Reviews, 2001 Apr; 81(2): 929-969.
18- Im I, Jun J, Hwang S, Ko M. Swallowing outcomes in patients with subcortical stroke associated with lesions of the caudate nucleus and insula. Journal of International Medical Research. 2018;46(9):3552-3562.
19- Saylam C, Ucerler H, Orhan M, Cagli S, Zileli M. The relationship of the posterior inferior cerebellar artery to cranial nerves VII–XII. Clinical Anatomy. 2007;20(8):886-891.
20- Inamasu J, Nakae S, Kato Y, Hirose Y. Clinical Characteristics of Cerebellar Infarction Due to Arterial Dissection. Asian Journal of Neurosurgery, 2018;13(4): 995-1000.
21- Oshima F, Yokozeki M, Hamanaka M, Imai, K., Makino, M., Kimura, M., Fujiu-Kurachi, M. Prediction of Dysphagia Severity: An Investigation of the Dysphagia Patterns in Patients with Lateral Medullary Infarction. Internal medicine. 2013; 52(12):1325-1331.
22- Martin R, Goodyear B, Gati J, Menon R. Cerebral cortical representation of automatic and volitional swallowing in humans. Journal of Neuropsychology, 2001;85(2):928-950.
23- Martino R, Terrault N, Ezerzer F, Mikulis D, Diamant N. Dysphagia in a patient with lateral medullary syndrome: insight into the central control of swallowing. Gastroenerology, 2001;121(2);420-426.
24- Amri M, Car A. Projections from the medullary swallowing center to the hypoglossal motor nucleus: a neuroanatomical and electrophysiological study in sheep. Brain Research. 1988;441(1-2):119-126.
25- Aydogdu I, Ertekin C, Tarlaci S, Turman B, Kiylioglu N, Secil Y. Dysphagia in Lateral Medullary Infarction (Wallenberg’s Syndrome). Stroke. 2001;32(9):2081-2087.
26- Hinchey J, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal Dysphagia Screening Protocols Prevent Pneumonia. Stroke. 2005;36(9):1972-1976.
27- Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A et al. Dysphagia Bedside Screening for Acute-Stroke Patients. Stroke. 2007;38(11):2948-2952.
28- Daniels S, Pathak S, Rosenbek J, Morgan R, Anderson J. Rapid Aspiration Screening for Suspected Stroke: Part 1: Development and validation. Archives of Physical Medicine and Rehabilitation. 2016;97(9):1440-1448.
29- Daniels S, Huckabee M, Gozdzikowska K. Dysphagia following stroke. San Diego: Plural Publishing; 2019.
30- ASHA. Knowledge and Skills Needed by Speech and Language Pathologist Providing Services to Individuals with Swalloving and/or Feeding Disorders. Preuzeto iz American Speech-Language-Hearing Association: asha.org. 2002.
31- Miles A, Zheng I, McLauchlan H, Huckabee M. Cough Reflex Testing in Dysphagia Following Stroke: A Randomized Controlled Trial. Journal of Clinical Medicine Research. 2013;5(3):222-223.
32- Desuter G. Oropharyngeal Dysphagia. Brussels: Springer International Publishing; 2019.
33- Jones C, Ciucci M, Hammer M, McCulloch T. A multisensor approach to improve manometric analysis of the upper esophageal sphincter. The Laryngoscope. 2015;126(3):657-664.
34- Martino R, McCulloch T. Therapeutic intervention in oropharyngeal dysphagia. Nature Reviews Gastroenterology & Hepatology. 2016;13(11):665-679.
35- Easterling C, Grande B, Kern M, Sears K, Shaker R. Attaining and Maintaining Isometric and Isokinetic Goals of the Shaker Exercise. Dysphagia. 2005;20(2):133-138.
36- Logemann J, Rademaker A, Pauloski B, Kelly A, Stangl-McBreen C, Antinoja J et al. A Randomized Study Comparing the Shaker Exercise with Traditional Therapy: A Preliminary Study. Dysphagia. 2009;24(4):403-411.
37- Veis S, Logemann J, Colangelo L. Effects of Three Techniques on Maximum Posterior Movement of the Tongue Base. Dysphagia. 2000;15(3):142-145.
38- Fujiu M, Logemann J. Effect of a Tongue-Holding Maneuver on Posterior Pharyngeal Wall Movement During Deglutition. American Journal of Speech-Language Pathology. 1996;5(1):23-30.
39- Lazarus C, Logemann J, Song C, Rademaker A, Kahrilas P. Effects of Voluntary Maneuvers on Tongue Base Function for Swallowing. Folia Phoniatrica et Logopaedica. 2002;54(4):171-176.
40- Kaatzke-McDonald M, Post E, Davis P. The effects of cold, touch, and chemical stimulation of the anterior faucial pillar on human swallowing. Dysphagia. 1996;11(3):198-206.
41- Humbert I, Michou E, MacRae P, Crujido L. Electrical Stimulation and Swallowing: How Much Do We Know? Seminars in Speech and Language. 2012;33(3):203-216.
42- Shaw G, Sechtem P, Searl J, Keller K, Rawi T, Dowdy E. Transcutaneous Neuromuscular Electrical Stimulation (VitalStim) Curative Therapy for Severe Dysphagia: Myth or Reality? Annals of Otology, Rhinology & Laryngology. 2007;116(1):36-44.
1- Srivastava M, Abeetha S, Srivastava S. Posterior inferiror cerebellar artery syndrome. International Journal of Healthcare and Biomedical Research, 2015;3 (2):76-79.
2- Pavlović S, Stefanović N, Vučetić R, Antić S, Čukuranović R, Arsić S. Anatomija centralnog nervnog sistema i čula. Niš: Sven; 2006.
3- Bian R, Choi I, Kim J, Han J, Lee S. Impaired Opening of the Upper Esophageal Sphincter in Patients with Medullary Infarctions. Dysphagia. 2008;24(2):238-245.
4- Sacco R, Freddo L, Bello A, Odel G, Onesti T, Mohr P. Wallenbergs lateral medullary syndrome. Clinical magnetic resonance imaging correlation. Archives of neurology. 1993; 50 (6):609-614
5- Daniels S. Neurological disorders affecting oral, pharyngeal swallowing. GI Motility. 2006.
6- Vuković M. Poremećaji komunikacije kod traumatskih oštećenja mozga. Beograd: Univerzitet u Beogradu – Fakultet za specijalnu edukaciju i rehabilitaciju; 2012.
7- Saitoh E, Pongpipatbaiboon K, Inamoto Y, Kagaya H. Dysphagia Evaluation and Treatment. Singapore: Springer; 2018.
8- Logemann J. Evaluation and Treatment of Swallowing Disorders. Austin: Pro-ed; 1998.
9- Matsuo K, Palmer J. Anatomy and Physiology of Feeding and Swallowing - Normal and Abnormal. Physical Medicine and Rehabilitation Clinics of North America, 2008 Nov;19(4):691-707
10- Jiang E, Lyu Q, Lin F, You T, Jiang L. Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome: Two case reports. World Journal of Clinical Cases, 2020 Mart; 8(6):1142-1149
11- Miller J. Characteristics of the swallowing reflex induced by peripheral nerve and brainstem stimulation. Experimental Neurology, 1972; 34 (2):210-222.
12- Bautista G, Dutschmann M. Pontomedullary nuclei involved in the generation of sequential pharyngeal swallowing and concomitant protective laryngeal adduction in situ. Journal of Physiology, 2014 Jun; 592 (12):2605-2623.
13- Harris Warrick M. General principles of rhythmogenesis in central pattern generator networks. Progress in brain research, 2010; 187: 213-222.
14- Morquette P, Lavoie R, Fhima D, Lamoureux X, Verdier D, Kolta A. Generation of the masticatory central pattern and its modulation by sensory feedback. Progress in Neurobiology, 2012 Mart; 96(3):340-355.
15- Guertin A, Steuer I. Key central pattern generators of the spinal cord. Journal of Neuroscience Research, 2009: 87 (11): 2399-2405.
16- Abdala P, Rybak A, Smith C, Zoccal B, Machado H, St-John M, Paton F. Multiple pontomedullary mechanisms of respiratory rhythmogenesis. Respiratory Physiology & Neurobiology, 2009; 168:19-25.
17- Jean A. Brainstem control of swallowing: Neuronal network and cellular mechanisms. Physiological Reviews, 2001 Apr; 81(2): 929-969.
18- Im I, Jun J, Hwang S, Ko M. Swallowing outcomes in patients with subcortical stroke associated with lesions of the caudate nucleus and insula. Journal of International Medical Research. 2018;46(9):3552-3562.
19- Saylam C, Ucerler H, Orhan M, Cagli S, Zileli M. The relationship of the posterior inferior cerebellar artery to cranial nerves VII–XII. Clinical Anatomy. 2007;20(8):886-891.
20- Inamasu J, Nakae S, Kato Y, Hirose Y. Clinical Characteristics of Cerebellar Infarction Due to Arterial Dissection. Asian Journal of Neurosurgery, 2018;13(4): 995-1000.
21- Oshima F, Yokozeki M, Hamanaka M, Imai, K., Makino, M., Kimura, M., Fujiu-Kurachi, M. Prediction of Dysphagia Severity: An Investigation of the Dysphagia Patterns in Patients with Lateral Medullary Infarction. Internal medicine. 2013; 52(12):1325-1331.
22- Martin R, Goodyear B, Gati J, Menon R. Cerebral cortical representation of automatic and volitional swallowing in humans. Journal of Neuropsychology, 2001;85(2):928-950.
23- Martino R, Terrault N, Ezerzer F, Mikulis D, Diamant N. Dysphagia in a patient with lateral medullary syndrome: insight into the central control of swallowing. Gastroenerology, 2001;121(2);420-426.
24- Amri M, Car A. Projections from the medullary swallowing center to the hypoglossal motor nucleus: a neuroanatomical and electrophysiological study in sheep. Brain Research. 1988;441(1-2):119-126.
25- Aydogdu I, Ertekin C, Tarlaci S, Turman B, Kiylioglu N, Secil Y. Dysphagia in Lateral Medullary Infarction (Wallenberg’s Syndrome). Stroke. 2001;32(9):2081-2087.
26- Hinchey J, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal Dysphagia Screening Protocols Prevent Pneumonia. Stroke. 2005;36(9):1972-1976.
27- Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A et al. Dysphagia Bedside Screening for Acute-Stroke Patients. Stroke. 2007;38(11):2948-2952.
28- Daniels S, Pathak S, Rosenbek J, Morgan R, Anderson J. Rapid Aspiration Screening for Suspected Stroke: Part 1: Development and validation. Archives of Physical Medicine and Rehabilitation. 2016;97(9):1440-1448.
29- Daniels S, Huckabee M, Gozdzikowska K. Dysphagia following stroke. San Diego: Plural Publishing; 2019.
30- ASHA. Knowledge and Skills Needed by Speech and Language Pathologist Providing Services to Individuals with Swalloving and/or Feeding Disorders. Preuzeto iz American Speech-Language-Hearing Association: asha.org. 2002.
31- Miles A, Zheng I, McLauchlan H, Huckabee M. Cough Reflex Testing in Dysphagia Following Stroke: A Randomized Controlled Trial. Journal of Clinical Medicine Research. 2013;5(3):222-223.
32- Desuter G. Oropharyngeal Dysphagia. Brussels: Springer International Publishing; 2019.
33- Jones C, Ciucci M, Hammer M, McCulloch T. A multisensor approach to improve manometric analysis of the upper esophageal sphincter. The Laryngoscope. 2015;126(3):657-664.
34- Martino R, McCulloch T. Therapeutic intervention in oropharyngeal dysphagia. Nature Reviews Gastroenterology & Hepatology. 2016;13(11):665-679.
35- Easterling C, Grande B, Kern M, Sears K, Shaker R. Attaining and Maintaining Isometric and Isokinetic Goals of the Shaker Exercise. Dysphagia. 2005;20(2):133-138.
36- Logemann J, Rademaker A, Pauloski B, Kelly A, Stangl-McBreen C, Antinoja J et al. A Randomized Study Comparing the Shaker Exercise with Traditional Therapy: A Preliminary Study. Dysphagia. 2009;24(4):403-411.
37- Veis S, Logemann J, Colangelo L. Effects of Three Techniques on Maximum Posterior Movement of the Tongue Base. Dysphagia. 2000;15(3):142-145.
38- Fujiu M, Logemann J. Effect of a Tongue-Holding Maneuver on Posterior Pharyngeal Wall Movement During Deglutition. American Journal of Speech-Language Pathology. 1996;5(1):23-30.
39- Lazarus C, Logemann J, Song C, Rademaker A, Kahrilas P. Effects of Voluntary Maneuvers on Tongue Base Function for Swallowing. Folia Phoniatrica et Logopaedica. 2002;54(4):171-176.
40- Kaatzke-McDonald M, Post E, Davis P. The effects of cold, touch, and chemical stimulation of the anterior faucial pillar on human swallowing. Dysphagia. 1996;11(3):198-206.
41- Humbert I, Michou E, MacRae P, Crujido L. Electrical Stimulation and Swallowing: How Much Do We Know? Seminars in Speech and Language. 2012;33(3):203-216.
42- Shaw G, Sechtem P, Searl J, Keller K, Rawi T, Dowdy E. Transcutaneous Neuromuscular Electrical Stimulation (VitalStim) Curative Therapy for Severe Dysphagia: Myth or Reality? Annals of Otology, Rhinology & Laryngology. 2007;116(1):36-44.
Published
2025/12/21
Section
Pregledni rad / Review article