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  • 1
    Electronic Resource
    Electronic Resource
    Cricopharyngeal myotomy may be effective treatment for selected patients with neurogenic oropharyngeal dysphagia (1995)
    Springer
    Dysphagia 10 (1995), S. 255-258 
    Details
    ISSN: 1432-0460
    Keywords: Cricopharyngeal myotomy ; Deglutition ; Deglutition disorders ; Neurogenic dysphagia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The role of cricopharyngeal (CP) myotomy in the management of neurogenic oropharyngeal dysphagia remains controversial. A review of the literature regarding outcomes of CP myotomy for dysphagia in the setting of a variety of neurological disorders indicates a preponderance of favorable results. There are several potential explanations for reported improvement after CP myotomy for neurogenic dysphagia, including the possibility that it is an effective treatment, at least for selected patients. If this is true, appropriate selection criteria for this treatment of neurogenic dysphagia may include (1) intact voluntary initiation of swallowing, (2) adequate propulsive force generated by the tongue and pharyngeal constrictors, (3) videofluorographic demonstration of obstruction to bolus flow at the CP segment (rather than merely retention in the pharyngeal recesses), (4) manometric evidence of relatively elevated CP pressure in relation to the pharynx, and (5) relatively favorable neurological prognosis. The effectiveness and safety of CP myotomy for patients with neurogenic dysphagia are unlikely to be resolved without a prospective, controlled multicenter study enrolling patients who meet such criteria.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00431418
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Oropharyngeal dysphagia due to iatrogenic neurological dysfunction (1995)
    Springer
    Dysphagia 10 (1995), S. 248-254 
    Details
    ISSN: 1432-0460
    Keywords: Deglutition ; Deglutition disorders ; Iatrogenic disorders ; Neurogenic dysphagia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Oropharyngeal dysphagia due to iatrogenic neurological dysfunction may relate to either medication side effects or surgical complications. There are several general mechanisms by which neurological side effects of medications can cause or aggravate oropharyngeal dysphagia. These include decreased level of arousal, direct suppression of brainstem swallowing regulation, movement disorders (dyskinesias, dystonias, and parkinsonism), neuromuscular junction blockade, myopathy, oropharyngeal sensory impairment, and disturbance of salivation. Postsurgical oropharyngeal dysphagia due to neurological dysfunction has been described in association with carotid endarterectomy, esophageal cancer surgery, anterior cervical fusion, and ventral rhizotomy for spasmodic torticollis. A potential explanation for oropharyngeal dysphagia following these surgical procedures is intraoperative mechanical disruption of the innervation of the pharyngeal constrictor muscles by the pharyngeal plexus. Posterior fossa and skull base surgery can lead to dysphagia as a result of intraoperative damage to brainstem centers and/or cranial nerves involved in swallowing. Perioperative stroke is the most likely explanation for oropharyngeal dysphagia appearing acutely following surgery, especially if the type of surgery predisposes to embolism or hypoperfusion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00431417
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Swallowing therapy of neurologic patients: Correlation of outcome with pretreatment variables and therapeutic methods (1995)
    Springer
    Dysphagia 10 (1995), S. 1-5 
    Details
    ISSN: 1432-0460
    Keywords: Dysphagia ; Swallowing therapy ; Swallowing rehabilitation ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The results of swallowing therapy in 58 patients with neurologic disorders are presented. All patients received tube feeding, either partially or exclusively, at admission, and successful outcomes, defined as exclusively oral feeding, were achieved in 67% of patients over a median treatment interval of 15 weeks. A subset of 11 patients who had experienced disease onset 25 weeks or more prior to admission nonetheless had a similar success rate of 64%. No other pretreatment variable, including age, localization of lesion, type or degree of aspiration, or cognitive status, correlated with successful outcome. Indirect therapy methods such as stimulation techniques and exercises to enhance the swallowing reflex, alter muscle tone, and improve voluntary function of the orofacial, lingual, and laryngeal musculature were utilized in all but 1 patient. Direct methods including compensatory strategies such as head and neck positioning, and techniques such as supraglottic swallowing and the Mendelsohn maneuver were additionally employed in nearly one-half of patients. Swallowing therapy is associated with successful outcome, as defined by exclusively oral feeding, among patients with neurogenic dysphagia, regardless of pretreatment variables including time since disease onset. Indirect treatment methods appear to be effective when used either alone or in combination with direct methods. Achievement of oral feeding is not associated with undue risk of pneumonia. Further rigorous scientific studies are needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00261272
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Neurogenic dysphagia: What is the cause when the cause is not obvious? (1994)
    Springer
    Dysphagia 9 (1994), S. 245-255 
    Details
    ISSN: 1432-0460
    Keywords: Neurogenic dysphagia ; Oropharyngeal dysfunction ; Videofluoroscopy ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The potential causes of neurogenic oropharyngeal dysphagia in cases in which the underlying neurologic disorder is not readily apparent are discussed. The most common basis for unexplained neurogenic dysphagia may be cerebrovascular disease in the form of either confluent periventricular infacts or small, discrete brainstem stroke, which may be invisible by magnetic resonance imaging. The diagnosis of occult stroke causing pharyngeal dysphagia should not be overlooked, because this diagnosis carries important treatment implications. Motor neuron disease producing bulbar palsy, pseudobulbar palsy, or a combination of the two can present as gradually progressive dysphagia and dysarthria with little if any limb involvement. Myopathies, especially polymyositis, and myasthenia gravis are potentially treatable disorders that must be considered. A variety of medications may cause or exacerbate neurogenic dysphagia. Psychiatric disorders can masquerade as swallowing apraxia. The basis for unexplained neurogenic dysphagia can best be elucidated by methodical evaluation including careful history, neurologic examination, videofluoroscopy of swallowing, blood studies (CBC, chemistry panel, creatine kinase, B12, thyroid screening, and anti-acetylcholine receptor antibodies), electromyography, and magnetic resonance imaging (MRI) of the brain, plus additional procedures such as lumbar puncture and muscle biopsy as indicated. Little is known about aging and neurogenic dysphagia, specifically the relative contributions of natural age-related changes in the oropharynx and of diseases of the elderly, including periventricular MRI abnormalities, in producing dysphagia symptoms and videofluoroscopic abnormalities in this population.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00301918
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Clinically probable brainstem stroke presenting primarily as dysphagia and nonvisualized by MRI (1993)
    Springer
    Dysphagia 8 (1993), S. 235-238 
    Details
    ISSN: 1432-0460
    Keywords: Dysphagia ; Brainstem stroke/infarction ; Magnetic resonance imaging ; Swallowing ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Ten patients with clinically probable brain-stem stroke presenting primarily as acute dysphagia but without visible brainstem abnormality by MRI are described. The patients were evaluated with neurologic examinations, cinepharyngoesophagography, and brain MRI studies. Each patient solely or predominately experienced sudden pharyngeal dysphagia, and additional symptoms or signs other than dysphonia or dysarthria were scarce. Small vessel disease or cardiac embolism were the apparent causes of what appear to have been very discrete brainstem strokes in these patients. Acute pharyngeal dysphagia can be the sole or primary manifestation of brainstem stroke. A negative MRI study should not preclude consideration of this diagnosis, if brainstem stroke is otherwise clinically probable.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01354544
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    Paper (German National Licenses)
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