Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 27-year-old male intravenous drug user presented to the Emergency Department of St James's Hospital with a 1-week history of progressive dysphasia, dysphagia and difficulty 'holding his head up' and 'keeping his eyes open'. He also complained of increasing weakness in his upper limbs, as a result of which he kept dropping things. He was on a methadone program but was using both intravenous heroin and cocaine at the time of presentation. Examination of his motor function revealed generalized hypotonia, hyporeflexia and reduced power in both upper limbs. No sensory loss was observed. Co-ordination was intact. The clinical picture of a proximal symmetrical descending weakness and an absence of sensory loss was suggestive of botulism. Clostridium botulinum is a spore-forming, obligate anaerobe. The three forms of human botulism are food-borne, wound and intestinal. A fourth man-made form is produced from aerosolized botulinum toxin and results in inhalational botulism. A little as 1 g of aerosolized botulinum toxin has the potential to kill 1.5 million people. Toxin is detected in serum or stool specimens in only approximately 46% of clinically diagnosed cases. Treatment involves supportive care and early passive immunization with equine antitoxin. Patients should be regularly assessed for loss of gag and cough reflex, control of oropharyngeal secretions, oxygen saturation, vital capacity and inspiratory force. When respiratory function begins to deteriorate, anticipatory intubation is indicated. Early symptom recognition and early treatment with antitoxin are essential in order to prevent mortality, and to prevent additional cases, it is important to ascertain the presence of similar symptoms in contacts of the patient and local public health officials must be notified as one case may herald an outbreak. Given the continued threat of bioterrorism, the Centre for Disease Control Surveillance System in the United States must also be notified of any cases of botulism.
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PMID:Descending polyneuropathy in an intravenous drug user. 1617 64

Oropharyngeal dysphagia is frequent during the acute phase of stroke, but most patients recover. Dysphagia is related to higher incidence of aspiration, pneumonia and death. Frequently neither clinical history nor neurological evaluation predicts the presence of aspiration. In 64 patients not recovered from severe stroke after the acute phase with clinically suspected oropharyngeal dysphagia we investigated: (i) the correlation between clinical manifestations and videofluoroscopic findings; (ii) predictive factors of aspiration and silent aspiration. Clinical examination showed that 44% had impaired gag reflex, 47% cough during oral feeding, and 13% changes in voice after swallowing. Videofluoroscopy revealed some abnormality in 87%: 53% in the oral phase and 84% in the pharyngeal phase (aspiration in 66%; half being silent). Impaired pharyngeal safety was more frequent in posterior territory lesions and patients with a history of pneumonia (P<0.01). No correlation was found between clinical evaluation findings and presence of aspiration. Silent aspirations were more frequent in patients with previous orotracheal intubation (P<0.05) and abnormalities in velopharyngeal reflexes (P<0.05). We concluded that in patients not recovered from severe stroke after the acute phase and with suspected oropharyngeal dysphagia, clinical evaluation is of scant use in predicting aspiration and silent aspiration. Videofluoroscopic examination is mandatory in these patients.
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PMID:Oropharyngeal dysphagia after the acute phase of stroke: predictors of aspiration. 1648 10

A 51-year-old man developed sudden vertigo, right hearing loss and dysphagia. Examination revealed right Horner syndrome, spontaneous torsional-horizontal nystagmus, right central type facial palsy, dysarthria, reduced soft palate elevation without gag reflex, left hypesthesia, right dysmetria and imbalance. Audiometry and bithermal caloric tests documented right sensorineural hearing loss and canal paresis. Brain MRI and cerebral angiography documented right lateral medullary infarction from vertebral artery dissection, without involvement of other parts of the brainstem supplied by the anterior inferior cerebellar artery (AICA). This case suggests artery-to-artery embolism as a possible mechanism of isolated vertigo or hearing loss from labyrinthine infarction.
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PMID:Embolic internal auditory artery infarction from vertebral artery dissection. 1658 Jun 95

Idiopathic soft palate paralysis is an infrequent clinical entity, both in children and adults. We describe the clinical manifestations in two new cases, manifested by fluid dysphagia, rhinolalia, absent gag reflex, and nasal escape of fluids. The remission period is the shortest observed in published cases. Thirty-three reports have been published in the literature to data, 32 in children and adolescents and one in an adult. This paralysis suggests a viral etiology, affects mainly children, and resolves spontaneously.
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PMID:[Idiopathic soft palate hemiparalysis]. 1719 32

This is the first study to examine dysphagia assessment practices of UK/Ireland speech and language therapists. The aims were to (1) examine practice patterns across clinicians, (2) determine levels of consistency in practice, and (3) compare practices of clinicians in the UK/Ireland with those previously reported of clinicians in the United States. A questionnaire, developed for earlier U.S. research, was adapted following a pilot study. The resulting email survey was completed by 296 speech and language therapists working with dysphagic adults. Respondents were asked to rate how frequently they use 31 components of a clinical dysphagia examination. Consistency was determined by calculating the percentage of respondents who agreed on frequency of use. Low frequency of use was reported for four components: trials with compensatory techniques, obtain patient's drug history, assessment of speech articulation/intelligibility, and screening/assessment of mental abilities. Variability among clinicians was high, with inconsistency observed for 6/31 components (19%) and high consistency for only 10/31 (32%). Results were compared with data from the earlier U.S. study. Notable differences in practice were observed for five components: cervical auscultation, trials with compensatory techniques, gag reflex, assessment of sensory function, and screening/assessment of mental abilities. Inconsistency among UK/Ireland clinicians was higher than in the comparator U.S. study. The clinical implications of these findings are discussed.
Dysphagia 2007 Jul
PMID:Adult dysphagia assessment in the UK and Ireland: are SLTs assessing the same factors? 1729 97

Palatopharyngeal paresis has never been reported to be contralateral in the lateral medullary infarction (LMI). A 65-year-old lady with acute dorsolateral infarction in the left medulla presented mild hoarseness, mild dysphagia, mild gait ataxia along with marked hypalgesia and thermal anesthesia on the right limbs. To our surprise, palatal weakness was on the right side, instead of being on the left side as expected in typical Wallenberg syndrome. The palatal paresis was noted during voluntary phonation but turned into normal movement while gag reflex was induced. An involvement of corticobulbar fibers before synapsing into the ipsilateral caudal medulla or a selective involvement of the peri-ambigual reticular formation and/or its post-synaptic connection fiber destined to the contralateral swallowing center presumably underlies such a rare contralateral palatal paresis.
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PMID:Lateral medullary infarction presenting contralateral palatal paresis. 1928 Aug 67

We investigated the feeding method and predictors for oral intake difficulty for a month after acute stroke. In 107 consecutive patients, swallowing function was assessed using a bedside screening protocol within 48 h of admission. The method of feeding was followed for 4 weeks, and predictors for "non-oral intake" on admission and 4 weeks later were analyzed. Sixty-two patients (58%) were fed any type of food orally within 48 h of admission, and 91 patients (84%) were fed orally 4 weeks later. Independent predictors for non-oral intake within 48 h of admission were consciousness disturbance (not completely alert; OR = 12.3), absence of gag reflex (OR = 5.34), and NIHSS score (OR = 1.20 per one point). Independent predictors for non-oral intake after 4 weeks were absence of gag reflex (OR = 7.95) and NIHSS score (OR = 1.13 per one point) on admission. Only four (9%) patients in the non-oral intake group within 48 h of admission and no patients in the non-oral intake group 4 weeks after admission were discharged to home. In acute stroke patients, absence of the gag reflex and severe neurologic deficits on admission predict prolonged dysphagia lasting longer than a month. Patients who could not eat orally had poor outcome.
Dysphagia 2010 Sep
PMID:Clinical significance of oral intake in patients with acute stroke. 1965 98

Foix-Chavany-Marie opercular syndrome is a severe form of pseudobulbar palsy occurring due to bilateral anterior opercular lesions. We report a case of a 51-year-old man with sudden onset of inability to speak and dysphagia, and a history of synovial sarcoma of the right hand. Detailed language evaluation was normal. The patient had right upper motor neuron facial paresis and absent gag reflex bilaterally. Magnetic resonance (MR) imaging revealed acute and subacute infarcts involving the bilateral insular cortex. Two-dimensional echocardiography and cardiac MR imaging showed a mobile mass in the left atrium attached to the interatrial septum, which was likely a myxoma. Chest radiograph and computed tomography imaging of the chest revealed multiple cannonball shadows that were suggestive of secondaries in the lung. The probable cause of the cerebral lesions was the mass lesion in the heart or metastatic lesions from the synovial sarcoma. The cardiac surgeon and surgical oncologist recommended palliative care.
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PMID:Bilateral perisylvian infarct: a rare cause and a rare occurrence. 2155 75

Although esophageal liposarcoma is an extremely rare tumor, liposarcoma is the most common soft tissue sarcoma in adults. Liposarcoma is currently classified into the types of well-differentiated, myxoid, round cell, pleomorphic and dedifferentiated liposarcoma. Up to now only a few cases of esophagus liposarcoma have been described in the world literature. We describe a myxoid type liposarcoma of the esophagus in a 68 year old man presented with hoarseness and intermittent dysphagea to solid food. He had a huge mass in his mouth which was mobile with gag reflex. A barium swallow, esophageal manometery and CT scan of the esophagus have not clearly revealed the mass. After endoscopic surgical resection of the tumor the histological examination revealed a myxoid liposarcoma. Both the presenting signs and symptoms and the histology type are rare for such tumor. This case demonstrate a rare differential diagnosis of intermittent dysphagia as early diagnosis is so important in those tumors and should kept in mind them, although they are quite rare.
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PMID:Huge myxoid liposarcoma of the esophagus: a case report. 2159 23

Collet-Sicard syndrome is a rare condition characterized by the unilateral paralysis of the 9th through 12th cranial nerves. We describe a case of a 46-year-old man who presented with dysphagia after a falling down injury. Computed tomography demonstrated burst fracture of the atlas. Physical examination revealed decreased gag reflex on the left side, decreased laryngeal elevation, tongue deviation to the left side, and atrophy of the left trapezius muscle. Videofluoroscopic swallowing study (VFSS) revealed frequent aspirations of a massive amount of thick liquid and incomplete opening of the upper esophageal sphincter during the pharyngeal phase. We report a rare case of Collet-Sicard syndrome caused by Jefferson fracture.
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PMID:Collet-sicard syndrome in a patient with jefferson fracture. 2250 24


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