Clinical and Imaging Assessments of Central Pharyngeal Muscle Function with Dysphagia in Acute Stroke

Objective: To explore the clinical and imaging assessments of pharyngeal muscle with dysphagia in acute stroke and the mechanism of the center pharyngeal muscle dysfunction(CPD) in stroke dysphagia so as to search for the effective treatment of CPD.Methods: The cranial MRI was done at the first onset of acute stroke patients on admission,and the locations of the lesion were recorded.According to locations,patients were divided into four groups: the left hemisphere group;the right hemisphere group;brain stem and cerebellum group;multi-site group.Clinical assessment of swallowing function was carried out within 24 h.The swallowing abnormalities of patients and the opening situation of pharynx were recorded.The patients with swallowing disorders received videofluoroscopic swallowing study(VFSS),and the patterns of dysphagia were determined and central pharyngeal muscle function was judged.Results: Of 100 consecutive patients with acute stroke,there were 40 cases of swallowing disorders assessed by using the clinical swallowing assessment.The VFSS was done in 30 patients.The pharyngeal muscle of 24 cases was normal,and 6 patients presented with CPD in the brain stem and cerebellum group,showing clinically moderate to severe dysphagia(2 patients were impaired on the otopharynx,and 4 cases only showed obstacles of pharynx).VFSS displayed that these 6 cases had significant abnormalities of the pharynx,and 5 had significantly reduced rate of laryngeal elevation;there were 4 cases of swallowing startup delay;there was one case of disability of center pharyngeal muscle open,and 5 cases of incomplete open.There were variety abnormal patterns of swallowing in the same patients,including lack of laryngeal elevation,more barium residue at the pyriform,laryngeal penetration and aspiration,etc.Conclusion: CPD occurred in locations of the brain stem stroke.It is often manifested with pharyngeal muscle spasm.The mechanisms involve in the degeneration of the corticobulbar channel of pharyngeal muscle.The consequences are that pharyngeal muscle becomes super-pharyngeal sphincter reflex.Although the incidence of CPD is not high,the impact on the quality of life of the patient is significant.