ABSTRACT
Dysphagia is a relatively rare symptom of neurovascular compression of the lower cranial nerve (CN). Many case reviews of neurovascular compression required surgical treatment to improve the neurological symptoms. This report presents a 75-year-old female patient who complained of dysphagia due to neurovascular compression of CNs IX-XI at the left side after the onset period. The symptom was improved by treating with balloon swallowing rehabilitation (BSR). In a video fluoroscopic swallowing study (VFSS), no significant manifestations were observed in the oral phase. On the other hand, profuse post-swallow residue decreased pharyngeal propulsion were observed without aspiration or penetration during the semisolid portion of the swallowing test. To reduce the pharyngeal remnant and improve pharyngeal propulsion, the BSR protocol was performed and the patient recovered quickly.Follow-up VFSS showed improvement in the post-swallow residue from 42.6 to 7.3%. After discharge, the patient could resume a normal diet without complications. Based on this observed result, it is advantageous to consider the option of a prescribed rehabilitation program over surgical treatment.
ABSTRACT
OBJECTIVE: To compare dysphagia between infratentorial stroke patients and supratentorial stroke patients. METHODS: Subjects of this study were patients with post-stroke dysphagia (PSD) who were admitted to our medical institution between May 2014 and June 2017. We evaluated a total of 64 patients with PSD. A videofluoroscopic swallowing study (VFSS) was performed to determine dysphagia severity. We measured the following parameters: pharyngeal transit time (PTT), post-swallow pharyngeal remnant, Penetration Aspiration Scale (PAS) scores, and Functional Dysphagia Scale (FDS). We analyzed patient's results from VFSS performed at admission. All VFSS images were recorded using a camcorder running at 30 frames per second. An AutoCAD 2D screen was used to measure post-swallow pharyngeal remnant. RESULTS: In this study, PTT and FDS were similar (p>0.05) between infratentorial stroke patients and supratentorial stroke patients. However, there were significant differences in pharyngeal remnant and PAS scores between the two groups (p<0.01 and p<0.05, respectively). CONCLUSION: Both pharyngeal remnant and PAS score registered higher levels from VFSS test for infratentorial stroke patients than those for supratentorial stroke patients. This suggests greater chances of problems occurring with swallowing, the major functions of pons. Thus, clinicians should pay particular attention to active dysphagia evaluation and treatment in PSD of infratentorial stroke patients.
Subject(s)
Humans , Deglutition , Deglutition Disorders , Fluoroscopy , Pons , Running , StrokeABSTRACT
This paper reports a case of a female patient aged 48 years diagnosed with a right lateral medullary infarction and dysphagia after the onset period. In a video fluoroscopic swallowing study (VFSS), significant manifestations were not observed in the oral phase, but during swallowing aspiration, a larger amount of post-swallowing residue were observed on the test of swallowing of semisolid and liquid. After the VFSS, a laryngoscopy was performed, which indicated paralysis and para-median fixation in the right vocal fold. In this case, swallowing with rightward head rotation was adopted as a compensation technique to reduce the aspiration caused by the para-median fixation of the right vocal fold, but it was not enough to improve the dysphagia in this case. To medialize the right vocal fold, hyaluronic acid was injected with laryngoscopic guidance. In a VFSS conducted after the injection, aspiration was not observed on the test of swallowing a semisolid and liquid. The injection of hyaluronic acid is less invasive than surgical operations, does not require general anesthesia, and makes the recovery time shorter. Therefore, it is expected to be an alternative to the treatment of unilateral vocal fold paralysis (UVFP) accompanied with dysphagia.