[Dysphagia] Silent aspiration

[eripley at yahoo.com (Irene Campbell-Taylor)]

From: "M. Tervo" <tervomm@yahoo.com>

 

Post surgery the pt had a declining status with confusion, impulsivity, and ataxic 

gait...however no CVA showed up on the CT. 

*** Any patient with an ataxic gait must be assessed for pontocerebellar impairment ? a major source of oropharyngeal swallowing impairment since several of the relevant cranial nerve bodies are located in the pons. This is why oculomotor examination is a mandatory part of the clinical examination- opthalmoplegia, nystagmus, Horner syndrome etc. It may be caused by an underlying pathology or by medication.

 

The Dr. ordered a MBS and the pt was aspirating every consistency.

*** I would check for any cerebellar or pontocereballar involvement including paraneoplastic syndromes in which the relvant cancer may not yet be identified.

.See:

Paraneoplastic cerebellar degeneration associated with antineuronal antibodies: analysis of 50 patients

Setareh Shams'ili,1 Joost Grefkens,1 Bertie de Leeuw,1 Martin van den Bent,1 Herbert Hooijkaas,2

Bronno van der Holt,3 Charles Vecht1 and Peter Sillevis Smitt1

 

Paraneoplastic cerebellar degeneration (PCD) is a heterogeneous group of disorders characterized by subacute cerebellar ataxia, specific tumour types and (often) associated antineuronal antibodies.  All patients presented with subacute cerebellar ataxia progressive over weeks to months and stabilized within 6 months. The majority of patients in all antibody groups had both truncal and appendicular ataxia. The frequency of nystagmus and dysarthria was lower in anti-Ri patients (33 and 0%).

 

Brain (2003), 126, 1409?1418

See also: Paraneoplastic Syndromes Involving the Nervous System

Robert B. Darnell, M.D., Ph.D., and Jerome B. Posner, M.D. N Engl J Med 2003;349:1543-54.

  

The common praneoplastic syndromes are:

Classical and non-classical paraneoplastic neurological syndromes

Syndromes of the central nervous system

Encephalomyelitis

Limbic encephalitis

Brainstem encephalitis

Subacute cerebellar degeneration

Opsoclonus-myoclonus

Optic neuritis_

Cancer associated retinopathy_

Melanoma associated retinopathy_

Stiff person syndrome

Necrotising myelopathy`

Motor neuron diseases`

Syndromes of the peripheral nervous system

Subacute sensory neuronopathy

Acute sensorimotor neuropathy

Guillain-Barre? syndrome`

Brachial neuritis`

Subacute/chronic sensorimotor neuropathies

Neuropathy and paraproteinaemia_

Neuropathy with vasculitis`

Autonomic neuropathies

Chronic gastrointestinal pseudo-obstruction

Acute pandysautonomia`

Syndromes of the neuromuscular junction and muscle

Myasthenia gravis_

Lambert-Eaton myasthenic syndrome`

Acquired neuromyotonia`

Dermatomyositis`

Acute necrotising myopathy`

 

 

 

 



Dr I Campbell-Taylor
Clinical Neuroscientist
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