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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A timed test of swallowing capacity has been designed for use in patients with neurogenic dysphagia. Swallowing speed (ml/s) has been demonstrated to have high intra- and inter- rater and test- retest reliability, and to be essentially independent of flavour or temperature. "Guideline" normal values were established in individuals without a swallowing disorder: swallowing speed was less in females than males and declined in both groups with age. The validity of a swallowing speed less than 10 ml/s as an index of abnormal swallowing was tested by comparison with the complaint of abnormal swallowing in a group of 81 neurological patients. Swallowing speed had a sensitivity of 96% and specificity of 69%: some apparent false positive responses were found in patients with disordered swallowing, mainly due to multiple sclerosis. Using a standard questionnaire and examination a similar pattern of symptoms and signs were statistically associated with both the clinical complaint of abnormal swallowing and swallowing speed. It is concluded that swallowing speed is a reliable and valid index for assessing disordered swallowing in neurological patients and may be of value in monitoring response to therapy.
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PMID:A timed test of swallowing capacity for neurological patients. 140 74

This report describes a rare complication after the resection of a tumor of the posterior fossa, the "one-and-a-half" syndrome. The one-and-a-half syndrome is a disturbance of horizontal eye movements in which patients have lateral gaze palsy in one direction and internuclear ophthalmoplegia in the other direction. The patient was a 54-year-old woman who developed headaches, diplopia, and blurred vision over 6 months. Computed tomographic scans and magnetic resonance imaging demonstrated an enhancing, mixed density, midline mass of the cerebellum. After a resection of the mass, an anaplastic astrocytoma, the patient complained of more severe diplopia and facial weakness. An examination disclosed a left one-and-a-half syndrome, left peripheral facial paralysis, dysarthria, dysphagia, mild left hemiparesis, dysmetria of the left upper limb, and truncal ataxia. The brain stem showed no abnormalities on postoperative computed tomographic scans. After 4 months of follow-up, the one-and-a-half syndrome had not improved, even though other signs had improved or resolved. This syndrome is caused by damage to structures within the pontine tegmentum: the medial longitudinal fasciculus, the ipsilateral paramedian pontine reticular formation, or the ipsilateral abducens nucleus. Multiple sclerosis and brain stem infarction are the most common causes of the one-and-a-half syndrome. Less frequently, it is caused by primary and metastatic tumors of the brain stem and cerebellum. Rarely, the one-and-a-half syndrome can develop postoperatively after the removal of tumors of the posterior fossa. The mechanism of pontine tegmental injury remains unknown.
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PMID:"One-and-a-half" syndrome after a resection of a midline cerebellar astrocytoma: case report and discussion of the literature. 196 11

The co-ordination of respiration and swallowing was recorded electronically in three groups of patients who complained of dysphagia following a stroke, or associated with multiple sclerosis or motor neurone disease. The test used was simple and the equipment easily taken to the patient, in bed if necessary. All the patients showed differences from normal subjects and there were differences between each of the neurologically impaired groups. The technique appears to allow an assessment of the state of oropharyngeal motor and sensory functions separately during swallowing.
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PMID:Respiratory patterns associated with swallowing: Part 2. Neurologically impaired dysphagic patients. 278 14

The patient who has multiple cranial neuropathies may pose a diagnostic dilemma. The neurologic disorders of amyotrophic lateral sclerosis, multiple sclerosis, myasthenia gravis, and poliomyelitis often cause bulbar dysfunctions such as diplopia, facial weakness, slurred or hypernasal speech, dysphagia, and hoarseness. In general, treatment is supportive and is directed toward restoring or aiding lost function (i.e., tracheostomy, esophagostomy, and cricopharyngeal myotomy). The relative infrequency of these disorders can lead to delays in diagnosis and rehabilitative therapy.
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PMID:Neurologic disorders: amyotrophic lateral sclerosis, myasthenia gravis, multiple sclerosis, and poliomyelitis. 710 59

Signs of respiratory distress including coughing, choking, and gagging are not uncommon during oral feedings in patients with severe dysphagia. Aspiration pneumonia and chronic lung disease are recognized complications. Pulse oximetry, respiratory inductance plethysmography, and nasal airflow measurement by thermistors are accurate noninvasive methods of monitoring cardiopulmonary adaptation during oral feedings in patients with severe dysphagia. We report significant, previously unrecognized, acquired hypoxemia during oral feedings in two patients with severe cerebral palsy and one with multiple sclerosis. The episodes of hypoxemia occurred only while swallowing specific food textures. Periods of hypoxemia most probably resulted from aspiration during oral feedings. Cardiopulmonary adaptation may prove to be an important consideration in decisions regarding the method and advisability of continued oral feedings in patients with severe dysphagia.
Dysphagia 1993
PMID:Hypoxemia during oral feedings in adults with dysphagia and severe neurological disabilities. 843 21

A 14-year-old boy was admitted to our Department due to peripheral palsy of right VII and bilateral of the VI cranial nerves, spasticity, cerebellar symptoms as well as to dysphagia and dysarthria. In general, he was hospitalized 13 times because of the disease of a relapsing-remitting and next progressive course. He died 31 years after onset of the disease. Multiple sclerosis was diagnosed. Brain autopsy revealed tumor involving almost all brain stem structures and a part of right cerebellar hemisphere. Histologically, cavernous angioma was diagnosed.
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PMID:Cavernous angioma of brain stem mimicking multiple sclerosis. 867 35

Dysphagia (difficulty in swallowing) is a common clinical symptom associated with many diseases, such as stroke, multiple sclerosis, neuromuscular diseases, and cancer. Its complications include choking, aspiration, malnutrition, cachexia, and dehydration. The goal in dysphagia management is to provide adequate nutrition and hydration while minimizing the risk of choking and aspiration. It is important to advance the individual toward oral feeding in a timely manner to enhance the recovery of swallowing function and preserve the quality of life. Current clinical assessments of dysphagia are limited in providing adequate guidelines for oral feeding. Mathematical modeling of the fluid dynamics of pharyngeal bolus transport provides a unique opportunity for studying the physiology and pathophysiology of swallowing. Finite element analysis (FEA) is a special case of computational fluid dynamics (CFD). In CFD, the flow of a fluid in a space is modeled by covering the space with a grid and predicting how the fluid moves from grid point to grid point. FEA is capable of solving problems with complex geometries and free surfaces. A preliminary pharyngeal model has been constructed using FEA. This model incorporates literature-reported, normal, anatomical data with time-dependent pharyngeal/upper esophageal sphincter (UES) wall motion obtained from videofluorography (VFG). This time-dependent wall motion can be implemented as a moving boundary condition in the model. Clinical kinematic data can be digitized from VFG studies to construct and test the mathematical model. The preliminary model demonstrates the feasibility of modeling pharyngeal bolus transport, which, to our knowledge, has not been attempted before. This model also addresses the need and the potential for CFD in understanding the physiology and pathophysiology of the pharyngeal phase of swallowing. Improvements of the model are underway. Combining the model with individualized clinical data should potentially improve the management of dysphagia.
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PMID:Mathematical modeling of normal pharyngeal bolus transport: a preliminary study. 970 16

In this observational study of patients with multiple sclerosis (MS) admitted to a regional neurology centre we assessed the frequency of dysphagia (objectively defined), dysphagia related symptoms, bulbar signs and nutritional status. We studied 79 consecutive admissions with MS (24 at diagnostic admission and 55 more advanced cases admitted for treatment and/or rehabilitation): normative swallowing data were from 181 healthy controls. Swallowing symptoms and signs were semi-quantitatively measured and compared to healthy controls. Dysphagia was defined by a quantitative water test. Disability was determined by Kurtzke's Expanded Disability Status Scale and Barthel's index. Nutritional status was assessed by body mass index, estimated percentage body fat from skin fold thickness measurements at four sites, a global evaluation of nutrition, the presence of pressure sores and the pressure sore risk using the Waterlow score. Patients with MS were more likely to complain of abnormal swallowing, of coughing when eating, and of food 'going down the wrong way' than healthy controls (P < 0.005). These significantly associated symptoms had high specificity but relatively low sensitivity. 43% of patients had abnormal swallowing, almost half of whom did not complain of it: abnormal swallowing was associated with several factors including abnormal brainstem/cerebellar function, disability, vital capacity, and depression score. Those with abnormal swallowing had higher Waterlow scores (P < 0.001), but, overall, abnormal swallowing was not associated with a difference in nutritional indices or incidence of pressure sores. In summary, abnormal swallowing is common in MS although often not complained of. It is associated with disordered brainstem/cerebellar function, overall disability, depressed mood and low vital capacity. It was not associated with major nutritional failure or pressure sores in this study.
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PMID:Dysphagia and nutritional status in multiple sclerosis. 1046 Apr 44

The development and patterns of respiratory failure (RF) are analyzed in 9 patients with disseminated sclerosis (DS). Forced ventilation of the lungs was carried out with consideration for main location of the process. Relationship between patterns of respiratory disorders and neuroanatomy of respiratory regulation is discussed. Involvement of the corticospinal routes is paralleled by dissociation during functional pulmonary tests: spontaneous volumes are less than controlled inspirations. The most severe symptom complexes were observed in RF of predominantly bulbar localization: respiratory anarchy, blocking of airways caused by impaired swallowing, impaired mechanism of coughing reflex, loss of spontaneous respiration, sometimes apnea during sleeping. Involvement of the respiratory nuclei of medullary respiratory center and airways and of the corticonuclear routes of caudal cranial nerves causes the development of a triad of symptoms: glossopharyngolaryngeal paralysis, dysfunction of respiratory nuclei of medulla oblongata, and decreased sensitivity of respiratory center to CO2. Aspiration complications caused by dysphagia are characteristic of bulbar DS. Respiratory function in 5 patients without clinical picture of RF are specially discussed. The authors emphasize unfavorable prognostic significance of signs of extracorporeal obstruction indicating the probability of RF long before its manifestation. Special attention is paid to early diagnosis of symptoms of coming RF when evaluating the status of patients with DS during treatment. Timely use of respiratory resuscitation methods reduces the mortality and ensures a good chance for remissions with recovery of respiratory function, which are characteristic of RF.
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PMID:[Respiratory failure in disseminated sclerosis]. 1101 1

Multiple sclerosis is a neurological disease that affects the I/II motor neurons of the CNS and its symptoms include oropharyngeal dysphagia. The onset and course of this dysphagia significantly conditions the progression of the disease. The present study evaluates the incidence on deglutition and type of alterations in a sampling of 10 multiple sclerosis patients of which 4 showed clinical signs of dysphagia. The results, obtained by combining quantitative (clinical severity) and qualitative (functional alterations) parameters showed that 9 of the 10 patients (90%) presented radiological abnormalities in the progression of the bolus. The conclusion drawn is that the high prevalence of dysphagia in multiple sclerosis, even if not always manifest clinically, justifies drawing up a standard protocol for radiological evaluation and clinical follow-up in order to screen those patients at greater risk of pulmonary complications and delay them as long as possible.
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PMID:[Videofluoroscopic study of deglutition in patients with multiple sclerosis]. 1128 62


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