Chapter 27 - Dysphagia and aspiration

Summary

In several stroke survivors, swallowing improves over time, although in a sizeable minority dysphagia is longer lasting. All dysphagic patients, including those with temporary swallowing impairments, are at a substantial risk of developing pneumonia. This chapter reviews pertinent aspects of swallowing physiology, and the neuroanatomy and patterns of swallowing impairments with different stroke locations. The facial motor nucleus and its associated nerve control the labial and facial muscles and participate in the oral and pharyngeal phases of swallowing. Dysphagia is often apparent early after stroke onset and improves with time. It rarely occurs in isolation and is typically accompanied by other telltale signs of bulbar dysfunction such as dysarthria, facial weakness or numbness, impaired cough, or impairment of alertness. Dysphagia and aspiration in the lateral medullary syndrome usually occur with involvement of the rostral and dorsolateral parts of the medulla oblongata.