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07.01.2019 | Original Article | Ausgabe 5/2019

Dysphagia 5/2019

Disruption of the Obligatory Swallowing Sequence in Patients with Wallenberg Syndrome

Zeitschrift:
Dysphagia > Ausgabe 5/2019
Autoren:
Mari Nakao, Fumiko Oshima, Yutaka Maeno, Shinich Izumi
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00455-018-09970-9) contains supplementary material, which is available to authorized users.

Abstract

Although the sequence of events involved in swallowing varies among healthy adults, healthy adults demonstrate some consistent patterns, including opening of the upper esophageal sphincter (UES) prior to maximum laryngeal elevation (LE). Previous animal studies suggested that swallowing is regulated by a neuronal network in the medulla, and lateral medullary infarction, or Wallenberg syndrome, frequently causes dysphagia. This retrospective, observational, multicenter study aimed to determine if the sequence of swallowing events was disturbed in patients with Wallenberg syndrome compared with previously published reference data for healthy adults. The study subjects included 35 patients with Wallenberg syndrome admitted to three hospitals in Japan from 1/4/2009 to 31/3/2017. Sixteen timing events, including maximum LE and UES opening, and the intervals between events were measured. If the sequence of events was the same as in healthy adults, the interval value was positive, and if the sequence of events was opposite to that in healthy adults, the value was negative. The median interval from UES opening to maximum LE was − 0.02 s (range − 0.80 to 0.89, 95% CI − 0.14 to 0.10). About half of the Wallenberg cases showed negative values indicating that the sequence was reversed. These results suggest that lateral medullary infarction impairs the sequence of swallowing events.

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