Aspiration penumonia in a patient with stroke

In context to the patient with dysphagia .

Full details of case in link shared below .

http://yashwanthmynenirollno111.blogspot.com/2021/10/a-61ym-with-seizures-secondary-to.html.

 question 1- patient had left hemiparesis - So right CVA ( non dominant hemisphere ) 

Can dysphagia occur with non dominant hemisphere lesion ? 

Reviewed literature regarding mechanism of dysphagia in stroke ! .

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563739/

Swallowing musculature Is represented bilaterally and assymetrically in motor cortices .

 

 2-Identification of dysphagia

Swallowing assessments are generally split into bedside clinical examinations or instrumental investigations.

 

Bedside - watch for signs of dysphagia and aspiration after giving small volume of food / liquid .

 Among other signs, clinicians will look for loss of liquid from the mouth, dyspraxia or poor coordination of muscles, facial weakness, delayed pharyngeal/laryngeal elevation, coughing or throat clearing, breathlessness, and changes in voice quality after swallow.

 

Objective assessment

 - gold standard - video fluoroscopy.

- fibre optic endoscopic evaluation -Videofluoroscopy is a commonly available investigation for the assessment of swallowing. Data are available on anatomy, all stages of swallowing physiology, the presence of aspiration, and the response to therapeutic manoeuvres. It does however, entail ionising radiation and is performed in somewhat artificial settings.

3- Clinical course - 

Recovery is common , patients recover within weeks - months .

The conclusion drawn was that recovery from dysphagia after stroke might follow reorganisation of the unaffected motor cortex.

4- Management 

NPO in patients with dysphagia 

NG feeds / PEG feeds .

 Difference between pseudobulbar and bulbar palsy .