Posted on Authorea 8 Oct 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160218246.64769641/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. ejr Kunieda Kenjiro syndrome medullary dysphagia lateral severe to in due phase pharyngeal the during Incoordination Shigematsu ejr Kunieda Kenjiro medullary lateral to Authors: due dysphagia severe title: Running in phase pharyngeal syndrome the during Incoordination 2020 8, October 2 1 lnclMessage: Clinical sphincter esophageal upper erator, words Key consent. informed provided consent: Informed Acknowledgments: [email protected] address: E-mail Fax: 6254. 230 58 +81 Phone: Japan 501-1194, Medicine. Gifu of Yanagido, School 1-1 Graduate University Gifu Neurology, of Department Kunieda Kenjiro author: Corresponding interest: of Conflict Japan Hamamatsu, Hospital, Rehabilitation Funding: City Japan Hamamatsu Hamamatsu, Dentistry, Hospital, of Rehabilitation Department City Japan 3. Hamamatsu Gifu, Medicine, Medicine, Rehabilitation of of School Department Graduate 2. University Gifu Neurology, of Department 1. Kanazawa aaas iyRhbltto Hospital Rehabilitation Medicine City of Hamamatsu School Graduate University Gifu

8 8206252. 230 58 +81 2 None cioFujishima Ichiro , aea eulr ydoe ihrslto aoer,icodnto,cnrlptengen- pattern central incoordination, manometry, high-resolution syndrome, medullary lateral : 2 iek Kanazawa Hideaki , 1,2 eeedshgadet LMS to due dysphagia Severe 1 aauiSugi Takafumi , aauiSugi Takafumi , None hssuywsapoe yteEhc omte forhsia.Tepatient The hospital. our of Committee Ethics the by approved was study This h uhr tt htte aen oflcso interest. of conflicts no have they that state authors The 2 2 ooiaOhno Tomohisa , 2 n cioFujishima Ichiro and , 2 ooiaOhno Tomohisa , 1 3 kk Nomoto Akiko , 2 kk Nomoto Akiko , 2 3 aah Shigematsu Takashi , 2 Takashi , 2 Hideaki , Posted on Authorea 8 Oct 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160218246.64769641/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. EC a rmtclyhg wn oanra E lsn.Tewaee hrnelcnrcinand his contraction whereas pharyngeal weakness, weakened contractile The subjects, pharyngeal pharyngeal closing. normal of to UES indicator with owing abnormal useful Compared to low a owing were high as values functions. dramatically x act MHPCI muscular was amplitude can and UES UESCI It as VPCI and patient’s calculated pharyngeal mmHg. gradient this was of 20 pressure CI representations the The [?] evaluate objective contraction function. to muscular contractility UES disorders. of of swallowing impaired measure length during an a x strongly and as duration closed contraction CI UES swallowing. pharyngeal zero pharyngeal during the to between abnormally the that drops increased calculated was pressure patient we UES study our swallowing, Notably, this in normal pressure of During UES LMS. dyspha- finding whereas severe with primary below, patient of The pathophysiology dysphagic or the bulbar HRM. clarify a using biomechanically in LMS swallowing to report to first due the gia was this knowledge, our To hospital. our of outpatient Committee an Ethics on treatment the Discussion receiving by and the approved home after was at months study rehabilitation 16 swallowing This discharged his was basis. balloon continuing He is (i.e., therapies). He swallowing rehabilitation onset. vacuum swallowing initial and and exercise, training, Shaker respiratory dilation, treatment, catheter nutritional received patient The 713.7 was UESCI the eeec ausfrti ain aa h PIadMPIvle o Lo hcee iud nour in liquids thickened of mL 3 for values MHPCI and VPCI the 124.3 4.1 data, were patient were report previous this values for (Fig. (MHPCI) values zone using CI reference muscle mmHg measured mesohypopharyngeal UES was (CI; pass and the UES integral not (VPCI) of and contractile did constriction pharynx pharyngeal and strong the the sinus pressure. and along used pyriform pressure constriction We the swallowing pharyngeal in The 3). weak remained revealed 2). bolus HRM The HRM. (Fig. impaired pharynx an function. the and (UES) contractility through pharyngeal sphincter weak revealed esophageal deficit (VF) neurological upper swallowing of His a examination percutaneous videofluoroscopic with a initiated. A department treatment. underwent rehabilitation diagnosed was dysphagia he the to therapy was for onset, transferred hospital the was antiplatelet He he our after oral onset, of months the and after Eleven dysphagia. months Fourteen 1), dysphagia. and gastrostomy. severe endoscopic hoarseness, for (Fig. except infarction disorder, improved to almost gait due with LMS presented left man 41-year-old A pathophysi- LMS. the to examine due to dysphagia Report used bulbar was Case severe (HRM) with manometry patient high-resolution a which of in case ology a using present LMS we et with Herein, Fujishima patients (NA) dysphagia swallowing. in ambiguus of swallowing nucleus phases during patietns. the pharyngeal incoordination the includes pharyngeal sensor. of life. and coordinates which conventional part of UES (NTS), center, lateral quality reported solitarius swallowing decreased the tractus al. the and of nucleus that mortality, the lesion suggested increased and the have malnutrition, by studies pneumonia, caused Previous aspiration disease with neurological associations a oblongata. is medulla (LMS) the syndrome pressure reversed medullary a swallowing.Lateral be during may opening syndrome UES medullary and contractility lateral Introduction pharyngeal to of due incoordination dysphagia by severe caused of gradient mechanisms the of One 1,2 3,4 h ain a xmndfrfiedysalw.Drn wloig h eohrnelCI velopharyngeal the swallowing, During swallows. dry five for examined was patient The 2 2 ± oee,teptohsooyo ypai a o enflyeuiae nthese in elucidated fully been not has dysphagia of pathophysiology the However, h Ii esr fte“io”o otatlt,adi a h oeta oprovide to potential the has it and contractility, of “vigor” the of measure a is CI The 1 ypai,acmo opiaino M,i lnclyipratbcueo its of because important clinically is LMS, of complication common a Dysphagia, 27 niaigsrn otato uigswallowing. during contraction strong indicating 72.7, ± 03ad193.2 and 50.3 ± 41 respectively 34.1, 2 · cm · 4 )t vlaetepayga swallowing pharyngeal the evaluate to s) ± .RgrigteptetsUSfunction, UES patient’s the Regarding ). . n 72.0 and 2.9 ± 62rsetvl (As respectively 16.2 Posted on Authorea 8 Oct 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160218246.64769641/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. iueLegends Figure References Fujishima Ichiro Kanazawa, Hideaki Shigematsu, manuscript the of Drafting data of interpretation and Analysis data of Acquisition design and concept Study LMS. to should due studies dysphagia Further severe contributions opening. of Author’s pressure UES reversed treatment a and and be contractility prognosis, may pharyngeal pathophysiology, oblongata of medulla the the limitation. incoordination elucidate in a the lesions to by be due caused dysphagia may gradient severe which of mechanisms topic, the of this One findings. on case report our verify case my- to only cricopharyngeal cases If Conclusion the apply additional relaxation. is evaluate could UES should This clinicians studies failed then treatment. future with approaches, Therefore, patients additional these these an with for as improvement beneficial treat- otomy sufficient nutritional be no exercise), would is Shaker training there and muscle dilation respiratory in catheter and incoordination, lesions balloon ment, contraction. pharyngeal to (i.e., and pharyngeal swallowing and rehabilitation due weak UES swallowing after and as pharynx dysphagia Continuous such sinuses closure, bulbar the function, forceful pyriform with UES of and the Patients and relaxation and muscles in pharyngeal UES contraction residue the in aspiration. abnormal pharyngeal deficits bolus subsequent control weak experience severe of cause CPG, may to can possibility LMS the NTS lead the and of may therefore, NA This medulla and, the lateral includes relaxation. pathophysiology. that the UES associated lesion abnormal in the LMS regarding an located reports Therefore, few NTS, the UES. been controls and have and there NA manipulates but The reported, medulla, been the sequence. have in LMS swallowing located causing the swallowing, of for phase (CPG) oropharyngeal generator pattern during central function larynx The reported UES sensors. the was conventional the of swallowing these evaluate studies. elevation during with the to these contractility pressure with UES UES necessary in down of is sensors elevation and conventional sensors and up using circumferential contraction moves pharyngeal with it Decreased catheter zone and precisely. high-pressure a asymmetric, The and Therefore, function. narrow swallowing swallowing. is of assessment UES quantitative in the and bolus of accurate a more a of provided passage HRM pharyngeal dysphagia. the bulbar with severe interfere with significantly patient swallowing this during UES closed dramatically Hg ,Tym ,Wtnb .Mnmti bomlt ndshgcptet fe medullary after patients dysphagic in abnormality Manometric T. Watanabe N, Tayama R, pharyngeal and Higo pressure 5. tongue between pha- Relationship of indicator al. useful et cricopharyngeal H, a Wakabayashi is at I, integral Fujishima passage contractile K, bolus Kunieda pharyngeal of The 4. A. Side Lazar K. K, 2020. Hojo Humphries C, A, dysphagia. O’Rourke Kojima review. R, 3. narrative Ohkuma a I, Shibamoto syndrome: medullary I, Fujishima lateral in 2. Dysphagia MS. Kim SH, Jang 1. eervsua ciet.OL trioayglRltSe.2002;64:368-72. Spec. Relat Otorhinolaryngol ORLJ print. accidents. cerebrovascular of pilot ahead a Online sarcopenia: doi:10.1007/s00455-020-10095-1. with patients 2020. dysphagia older Dysphagia. in study. manometry high-resolution using assessed function 2017;29:e13144. Motil. Neurogastroenterol impairment. swallowing 52(3):309-15. ryngeal 2000. Med. Neuro syndrome. Wallenberg’s in portion 10.1007/s00455-020-10158-3 doi: ejr uid,Tkfm ui kk Nomoto Akiko Sugi, Takafumi Kunieda, Kenjiro : ejr uid,TksiSieas,HdaiKnzw,Ihr Fujishima Ichiro Kanazawa, Hideaki Shigematsu, Takashi Kunieda, Kenjiro : ejr uid,Tkfm ui ooiaOn,AioNmt,Takashi Nomoto, Akiko Ohno, Tomohisa Sugi, Takafumi Kunieda, Kenjiro : ejr uid,Tmhs ho kk ooo cioFujishima Ichiro Nomoto, Akiko Ohno, Tomohisa Kunieda, Kenjiro : 2,5 ti icl opeieymauete“io”o abnormal of “vigor” the measure precisely to difficult is It 1 bomlte nteUSfnto wn odysphagia- to owing function UES the in Abnormalities 3 Posted on Authorea 8 Oct 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160218246.64769641/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. ptoeprlposo r wlos -xs ahtrpsto;Xai,tm.Pesr sidctdusing sphincter. UES indicated evaluated. esophageal pharynx. is are upper meso-hypo swallowing Pressure and UES: during velopharynx time. pressure the UES X-axis, at and measured position; pressures duration (b) catheter pharyngeal relaxation subject Maximum Y-axis, normal UES scale. a swallows. impaired color of the dry an and of (a) and plots patient contraction the Spatiotemporal pharyngeal of topographies weak Pressure to 3. owing Figure sinus pyriform the in onset relaxation. residue after months bolus 14 Severe swallowing (yellow of medulla examination dorsolateral Videofluoroscopic left 2. the Figure of region small a to confined arrow). intensity onset high after showing months image T2-weighted 14 imaging resonance Magnetic 1. Figure 4 Posted on Authorea 8 Oct 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160218246.64769641/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. 5