Dysphagia in Lateral Medullary Syndrome

Abstract

Introduction. The lateral medullary syndrome is a neurological disease caused by ischemia in the lateral part of the medulla oblongata and is the most common form of brainstem infarction. Dysphagia is a common and clinically significant symptom of this disease because it is closely associated with the risk of recurrent pneumonia, malnutrition, dehydration, and an increase in mortality and prolonged hospital treatment. Aim. This paper aims to review and analyze data on the correlation between swallowing disorders and lateral medullary syndrome. We intend to present the symptoms, diagnostic and therapeutic procedures of dysphagia in patients with this syndrome in a comprehensive way. Methodology. The following databases were used to search the literature: KoBSON-Consortium of Serbian Libraries for Unified Procurement, PubMed, Science Direct. Results. Based on the results of the reviewed studies, it was determined that patients with the lateral medullary syndrome often have swallowing disorders. They are often fed through a nasogastric tube a few months after the stroke, which significantly impairs their quality of life. To overcome swallowing disorders and create conditions for safe swallowing function, most patients need treatment for a longer period. In addition to the available screening tests, instrumental diagnostic methods provide insight into the biomechanical aspects of swallowing disorders, determine the risk of aspiration, and provide a starting point for selecting treatment strategies. Conclusion. Treatment of dysphagia depends on the mechanisms of occurrence and the predictors of recovery of swallowing function. When conducting treatment, among other things, it is very important to know the pathological mechanisms of neural connections of the medulla oblongata.

Uvod. Lateralni medularni sindrom je neurološko oboljenje izazvano ishemijom u bočnom delu produžene moždine i predstavlja najčešći oblik infarkta moždanog stabla. Disfagija je čest i klinički značajan simptom ovog oboljenja jer je usko povezana sa rizikom od ponovljene pneumonije, malnutricije, dehidracije, te sa povećanjem procenta mortaliteta i produženim bolničkim lečenjem. Cilj. Cilj ovog rada bio je pregled i analiza podataka o korelaciji poremećaja gutanja i lateralnog medularnog sindroma. Namera nam je da na sveobuhvatan način prikažemo simptome, dijagnostičke i terapijske procedure disfagije kod bolesnika sa ovim sindromom. Metodologija. Za pretraživanje literature korišćene su sledeće baze podataka: KoBSON – Konzorcijum biblioteka Srbije za objedinjenu nabavku, PubMed, Science Direct. Rezultati. Na osnovu rezultata pregledanih studija utvrđeno je da bolesnici sa lateralnim medularnim sindromom često imaju poremećaje gutanja. Oni se neretko hrane putem nazogastrične sonde i po nekoliko meseci nakon moždanog udara, što značajno narušava njihov kvalitet života. U cilju prevazilaženja smetnji u gutanju i stvaranja uslova za bezbednu funkciju gutanja, većina bolesnika ima potrebu za tretmanom u dužem vremenskom intervalu. Pored dostupnih skrining testova, instrumentalne dijagnostičke metode omogućavaju uvid u biomehaničke aspekte poremećaja gutanja, determinišu rizik od aspiracije i predstavljaju polaznu osnovu za odabir strategija tretmana. Zaključak. Tretman disfagije zavisi od mehanizama nastanka i faktora predikcije oporavka funkcije gutanja. Pri sprovođenju tretmana, pored ostalog, veoma je važno poznavanje patoloških mehanizama neuralnih veza produžene moždine.