Characteristics and Prognostic Factors of Swallowing Dysfunction in Patients with Lateral Medullary Infarction

Dysphagia is considered to be a significant barrier for recovery after lateral medullary infarction (LMI). However, there is still no gold standard treatment for dysphagia. The aim of this study was to explore an effect of an early treatment options for swallowing dysfunction after acute LMI. Medical records of acute LMI patients who had been admitted to the department of rehabilitation medicine from January 2014 to December 2017 were reviewed retrospectively. We compared the clinical efficacy of conventional dysphagia rehabilitation to early endoscopic intervention using either botulinum toxin injection into cricopharyngeal muscle or endoscopic balloon dilatation of the muscle. Outcomes, such as duration of parental feeding, albumin level at diet transition to enteral feeding, and complications, were analyzed. A total of 18 patients with LMI were included. While eight patients (8/9, 88.89%) in the endoscopic group were capable of orally ingesting their diet after intervention, the conversion from tube feeding to an oral diet was possible in only five patients (5/9, 55.56%) of the conventional group during hospitalization. However, the difference between the two groups was not significant (p-value ≤ 0.147, chi-square test). Only the final dietary level at the time of discharge was higher level in endoscopic group. The conversion interval from tube feeding to oral diet was also comparable between groups. There was no re-conversion from the oral diet to tube feeding in patients of either group during the median follow-up period of 20 months. Early endoscopic intervention may be a better option for dysphagia with LMI, compared to conventional dysphagia rehabilitation. However, a larger and prospective trial may be needed to confirm our observations.

Download Full-text

Effect of Transcutaneous Vagus Nerve Stimulation in Dysphagia After Lateral Medullary Infarction: A Case Report

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0262 ◽

2019 ◽

Vol 28 (4) ◽

pp. 1381-1387

Author(s):

Ying Yuan ◽

Jie Wang ◽

Dongyu Wu ◽

Dahua Zhang ◽

Weiqun Song

Keyword(s):

Vagus Nerve ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Rating Scale ◽

Tube Feeding ◽

Nasogastric Feeding ◽

Lateral Medullary Infarction ◽

Severe Dysphagia ◽

Transcutaneous Vagus Nerve Stimulation ◽

Medullary Infarction

Purpose Severe dysphagia with weak pharyngeal peristalsis after dorsal lateral medullary infarction (LMI) requires long-term tube feeding. However, no study is currently available on therapeutic effectiveness in severe dysphagia caused by nuclear damage of vagus nerve after dorsal LMI. The purpose of the present investigation was to explore the potential of transcutaneous vagus nerve stimulation (tVNS) to improve severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Method We assessed the efficacy of 6-week tVNS in a 28-year-old woman presented with persisting severe dysphagia after dorsal LMI who had been on nasogastric feeding for 6 months. tVNS was applied for 20 min twice a day, 5 days a week, for 6 weeks. The outcome measures included saliva spitted, Swallow Function Scoring System, Functional Oral Intake Scale, Clinical Assessment of Dysphagia With Wallenberg Syndrome, Yale Pharyngeal Residue Severity Rating Scale, and upper esophagus X-ray examination. Results After tVNS, the patient was advanced to a full oral diet without head rotation or spitting. No saliva residue was found in the valleculae and pyriform sinuses. Contrast medium freely passed through the upper esophageal sphincter. Conclusion Our findings suggest that tVNS might provide a useful means for recovery of severe dysphagia with weak pharyngeal peristalsis after dorsal LMI. Supplemental Material https://doi.org/10.23641/asha.9755438

Download Full-text

Lateral medullary infarction with ipsilateral hemiparesis, lemniscal sensation loss and hypoglossal nerve palsy

Neurological Sciences ◽

10.1007/s10072-014-1636-5 ◽

2014 ◽

Vol 35 (4) ◽

pp. 633-634 ◽

Cited By ~ 3

Author(s):

Xiaodi Li ◽

Yuzhou Wang

Keyword(s):

Nerve Palsy ◽

Hypoglossal Nerve ◽

Lateral Medullary Infarction ◽

Hypoglossal Nerve Palsy ◽

Sensation Loss ◽

Ipsilateral Hemiparesis ◽

Medullary Infarction

Download Full-text

Spontaneous, headshaking, and positional nystagmus in post-lateral medullary infarction dizziness

Journal of the Neurological Sciences ◽

10.1016/j.jns.2016.07.019 ◽

2016 ◽

Vol 368 ◽

pp. 249-253 ◽

Cited By ~ 8

Author(s):

Kazumitsu Amari ◽

Yosuke Kudo ◽

Kosuke Watanabe ◽

Masahiro Yamamoto ◽

Koji Takahashi ◽

...

Keyword(s):

Positional Nystagmus ◽

Lateral Medullary Infarction ◽

Medullary Infarction

Download Full-text

Lateral Medullary Infarction with Contralateral Segmental Dysesthesia and Ipsilateral Headache: A Case Report

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666211117142203 ◽

2021 ◽

Vol 17 ◽

Author(s):

Renjie Wang ◽

Yankun Shao ◽

Lei Xu

Keyword(s):

Medulla Oblongata ◽

Clinical Manifestations ◽

Lateral Medullary Infarction ◽

Case Presentation ◽

Specific Sign ◽

Temperature Sense ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

The Brain ◽

Medullary Infarction

Introduction: The medulla oblongata is the lowest segment of the brain stem, located adjacent to the spinal cord, with a complex anatomical structure. Thus, a small injury to the medulla oblongata can show complex clinical manifestations. Case Presentation: A patient experienced dysesthesia, which manifested as numbness in her right lower limb and decreased temperature sense, and dizziness 20 days before admission. The numbness worsened 1 week before admission, reaching the right thoracic (T) 12 dermatomes. Her thermoception below the T12 dermatomes decreased, and the degree of dizziness increased, accompanied by nausea and vomiting. Magnetic resonance imaging (MRI) of the neck, chest, and abdomen performed at a local hospital showed no abnormalities. MRI of the brain was performed after admission. One week after admission, she experienced a severe headache in the upper left periorbital area. The numbness extended to T4, and thermoception decreased below T4. Diagnosis: Lateral medullary infarction. Interventions: Anti-platelet aggregation and mitochondrial nutritional therapies were performed along with treatments for improving circulation and establishing collateral circulation. Outcomes: The intensity of limb numbness decreased, and the symptoms of headache and dizziness resolved. Conclusion: Lesions leading to segmental sensory disorders can occur in the medulla oblongata. Ipsilateral headaches with contralateral segmental paresthesia can be a specific sign of lateral medullary infarction.

Download Full-text