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November 1991

Dysphagia Following Brain-Stem StrokeClinical Correlates and Outcome

Author Affiliations

From the Speech and Language Pathology Program, Department of Surgery (Dr Homer and Ms Buoyer), the Division of Neurology, Department of Medicine (Dr Alberts), and the Division of Biometry, Department of Community and Family Medicine (Mr Helms), Duke University Medical Center, Durham, NC.

Arch Neurol. 1991;48(11):1170-1173. doi:10.1001/archneur.1991.00530230078026

We studied 23 individuals (16 men, seven women; mean age 57 years) who had brainstem strokes confirmed by computed tomography of the head or magnetic resonance imaging. Videofluoroscopic modified barium-swallowing examination showed aspiration in 15 of 23 patients. Of the 15 aspirating patients, the majority had bilateral strokes with multiple lesion loci, most often in association with large-vessel disease. All 15 patients had involvement of the pons or medulla. Statistical analyses revealed a significant association between aspiration and pharyngeal residue observed under videofluoroscopy, cranial nerve IX abnormality, vocal fold weakness, and severe dysarthria. Despite initial severity, recovery was good. Following an aggressive program of aspiration prevention, over 80% of patients resumed full oral nutrition at the last follow-up.