Characteristics of dysphagia in medullary and cerebellar stroke: an observational study based on HRPM and FEES.
Objective: To explore and compare the distinct characteristics of post-stroke dysphagia in patients with cerebellar and different medullary lesions using flexible endoscopic evaluation of swallowing (FEES) and high-resolution pharyngeal manometry (HRPM), by comparing with healthy controls.
Methods: Observational study. Methods: Department of rehabilitation medicine of an academic hospital. Methods: 20 healthy controls and 44 stroke patients (31 medullary stroke [10 medial medullary infarction (MMI), 21 lateral medullary stroke (LMS-S: nucleus tractus solitaries (NTS) involvement; LMS-A: only affecting nucleus ambiguous (NA))]; 13 cerebellar stroke) within 2 weeks-3 months post-stroke. All patients remained tube-fed [Functional Oral Intake Scale (FOIS) score ≤3] without prior swallowing rehabilitation. Methods: Not applicable. Methods: Outcome measures was assessed using FEES and HRPM, including Murray secretion scale, pharyngeal sensation test, swallow reflex, Rosenbek penetration-aspiration scale (PAS), Murray secretion scale, Yale pharyngeal residue severity rating scale, upper esophageal sphincter (UES) relaxation pressure and relaxation duration, pharyngeal peak pressure and contraction duration, pharyngeal sequencing.
Results: FEES results showed LMS-S has reduced pharyngeal sensation and delayed pharyngeal swallow initiation, but no significant differences in PAS score, residues or secretions among the groups. Medullary stroke patients had higher UES residual pressure and shorter UES relaxation duration than cerebellar stroke patients. Subgroup analysis revealed that the UES residual pressure in LMS-S group was significantly higher and the UES relaxation duration shorter compared to the cerebellar stroke group, whereas the UES relaxation duration, velopharyngeal peak pressure and constriction duration were all shorter in the LMS-A group compared to the cerebellar stroke group. Both LMS-S and cerebellar stroke patients had pharyngeal mis-sequencing.
Conclusions: Dysphagia characteristics are different in different lesions of medullary stroke and cerebellar stroke. Specific instrumental assessments based on lesions facilitates early intervention in individualised dysphagia rehabilitation.