Characteristics of Dysphagia in Medullary and Cerebellar Stroke: An Observational Study Based on HRPM and FEES.

Abstract

Objective: To explore and compare the distinct characteristics of poststroke 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.

Design: Observational study.

Setting: Department of rehabilitation medicine of an academic hospital.

Participants: Healthy individuals and stroke patients were enrolled (N=64). 20 healthy individuals and 44 stroke patients {31 medullary stroke [10 medial medullary infarction (MMI), 21 lateral medullary stroke (LMS-S: nucleus tractus solitaries involvement; LMS-A: only affecting nucleus ambiguous; 13 cerebellar stroke)]} within 2 weeks to 3 months poststroke. All patients remained tube-fed (Functional Oral Intake Scale score≤3) without prior swallowing rehabilitation.

Interventions: Not applicable.

Main outcome measures: Outcome measures were assessed using FEES and HRPM, including Murray secretion scale, pharyngeal sensation test, swallow reflex, Rosenbek penetration-aspiration scale (PAS), Yale pharyngeal residue severity rating scale, upper esophageal sphincter (UES) relaxation pressure and relaxation duration, pharyngeal peak pressure and contraction duration, and pharyngeal sequencing.

Results: FEES results showed LMS-S has reduced pharyngeal sensation and delayed pharyngeal swallow initiation, but no significant differences in PAS score, residue, 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 than the cerebellar stroke group. Both LMS-S and cerebellar stroke patients had pharyngeal missequencing.

Conclusions: Dysphagia characteristics are different in different lesions of medullary stroke and cerebellar stroke. Specific instrumental assessments based on lesions facilitates early intervention in individualized dysphagia rehabilitation.