This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ertekin, C. Articles by Kiylioglu, N. Search for Related Content PubMed PubMed Citation Articles by Ertekin, C. Articles by Kiylioglu, N. Pubmed/NCBI databases Medline Plus Health Information Paralysis Swallowing Disorders Related Collections Cerebral Lacunes Computerized tomography and Magnetic Resonance Imaging Other Stroke Treatment - Surgical

(Stroke. 2000;31:1370.)
© 2000 American Heart Association, Inc.

Original Contributions

Mechanisms of Dysphagia in Suprabulbar Palsy With Lacunar Infarct

Cumhur Ertekin, MD; Ibrahim Aydogdu, MD; Sultan Tarlaci, MD; A. Bulent Turman, MD, PhD Nefati Kiylioglu, MD

From the Departments of Neurology (C.E., I.A., S.T., N.K.) and Clinical Neurophysiology (C.E., I.A.), Medical School Hospital, Ege University, Bornova, Izmir, Turkey; and Department of Biomedical Sciences (A.B.T.), University of Sydney, Sydney, Australia.

Correspondence to Prof Dr Cumhur Ertekin, Nilhan Apt, 1357 Sok No: 1 D: 10, Alsancak, Izmir, Turkey. E-mail erteker@unimedya.net.tr or neuron{at}med.ege.edu.tr

Background and Purpose—The objective of the present study was to investigate the neural mechanisms of dysphagia in suprabulbar palsy (SBP) with multiple lacunar infarct.

Methods—We evaluated the swallowing disorders of patients with SBP (n=34) and age-matched healthy control subjects (n=35) by means of an electrophysiological method that recorded the oropharyngeal swallowing patterns. With this method, dysphagia limit, the triggering of voluntarily initiated swallows, duration of laryngeal relocation time, and total duration of oropharyngeal swallowing were recorded and measured. In addition, the EMG behavior of the cricopharyngeal (CP) muscle of the upper esophageal sphincter was also assessed.

Results—In patients with SBP, the dysphagia limit in all except 1 patient was pathological with limits of <20-mL bolus volume, which is contrary to normal subjects, in whom the dysphagia limit exceeds the 20-mL bolus volume. Either triggering of swallowing reflex was delayed (P<0.04), or the swallow could hardly be triggered in 7 patients on the voluntary attempts for 3 mL water. Whenever the reflex swallowing could be triggered, it was slow and prolonged (P<0.01). The CP muscle of the upper esophageal sphincter appeared to have become hyperreflexic and incoordinated with laryngeal movements during swallowing.

Conclusions—It was proposed that the progressive involvement of the excitatory and inhibitory corticobulbar fiber systems linked with the bulbar swallowing center is mainly responsible for the triggering difficulties of the swallowing reflex and for the hyperreflexic/incoordinated nature of the CP sphincter. In addition, the dysfunction of the extrapyramidal system has a specific role in the slowing of oropharyngeal swallowing and the accumulation of saliva in the mouth.

Key Words: dysphagia • electromyography • lacunar infarction • paralysis, bulbar • pharyngeal muscles

This article has been cited by other articles:

				R. Martino, N. Foley, S. Bhogal, N. Diamant, M. Speechley, and R. Teasell Dysphagia After Stroke: Incidence, Diagnosis, and Pulmonary Complications Stroke, December 1, 2005; 36(12): 2756 - 2763. [Abstract] [Full Text] [PDF]

				M. Kwon, J. H. Lee, and J. S. Kim Dysphagia in unilateral medullary infarction: Lateral vs medial lesions Neurology, September 13, 2005; 65(5): 714 - 718. [Abstract] [Full Text] [PDF]

				T. Iwamoto, S. Fukuda, M. Kikawada, M. Takasaki, and T. Imamura Prognostic Implications of Swallowing Ability in Elderly Patients After Initial Recovery From Stroke J. Gerontol. A Biol. Sci. Med. Sci., January 1, 2005; 60(1): 120 - 124. [Abstract] [Full Text] [PDF]

				C Ertekin, I Aydogdu, Y Secil, N Kiylioglu, S Tarlaci, and T Ozdemirkiran Oropharyngeal swallowing in craniocervical dystonia J. Neurol. Neurosurg. Psychiatry, October 1, 2002; 73(4): 406 - 411. [Abstract] [Full Text] [PDF]

				I. Aydogdu, C. Ertekin, S. Tarlaci, B. Turman, N. Kiylioglu, and Y. Secil Dysphagia in Lateral Medullary Infarction (Wallenberg's Syndrome): An Acute Disconnection Syndrome in Premotor Neurons Related to Swallowing Activity? Stroke, September 1, 2001; 32(9): 2081 - 2087. [Abstract] [Full Text] [PDF]

				C Ertekin, N Yuceyar, I Aydogdu, and H Karasoy Electrophysiological evaluation of oropharyngeal swallowing in myotonic dystrophy J. Neurol. Neurosurg. Psychiatry, March 1, 2001; 70(3): 363 - 371. [Abstract] [Full Text] [PDF]