Vigderman A M, Chavin J M, Kososky C, Tahmoush A J
Thomas Jefferson University, Philadelphia, PA 19107, USA.
J Neurol Sci. 1998 Mar 5;155(2):208-10. doi: 10.1016/s0022-510x(97)00307-9.
Although swallowing difficulties (dysphagia) frequently occur in acute brainstem infarction, physiological studies of dysphagia (videofluoroscopy, manometry) are rarely reported. We present a patient with ipsilateral Horner's syndrome, palatal and laryngeal weakness, aphagia, and ipsilateral face and contralateral extremity pin and temperature loss due to lateral medullary infarction confined to the rostral dorsolateral medulla (RDM). Videofluoroscopy showed that the patient was unable to initiate a swallow. Manometry showed a markedly reduced peak pharyngeal pressure and weak pharyngeal contractions. Within 20 months, the patient's neurological deficits resolved, videofluoroscopy showed a normal swallow, and manometry showed normal peak pharyngeal pressure. Correlation of the clinical, physiological, and imaging evaluations shows that aphagia and severe bilateral pharyngeal paresis can result from unilateral RDM infarction. We suggest that, in man, the bilateral medullary swallowing centers function as one integrated center, and that infarction of a portion of this center is sufficient to cause complete loss of swallowing.
尽管吞咽困难（吞咽障碍）在急性脑干梗死中经常出现，但关于吞咽障碍的生理学研究（电视荧光吞咽造影、测压法）却鲜有报道。我们报告了一名因局限于延髓背外侧嘴侧（RDM）的外侧延髓梗死而出现同侧霍纳综合征、腭部和喉部肌无力、吞咽不能以及同侧面部和对侧肢体针刺觉和温度觉丧失的患者。电视荧光吞咽造影显示该患者无法启动吞咽动作。测压显示咽峰压明显降低且咽部收缩无力。在20个月内，患者的神经功能缺损得以恢复，电视荧光吞咽造影显示吞咽正常，测压显示咽峰压正常。临床、生理学和影像学评估的相关性表明，单侧RDM梗死可导致吞咽不能和严重的双侧咽部麻痹。我们认为，在人类中，双侧延髓吞咽中枢作为一个整合中枢发挥作用，该中枢的一部分梗死就足以导致吞咽完全丧失。
