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32Neurology16 min read

The causes of disturbances of swallowing

1. Big picture

Disturbance of swallowing is dysphagia; complete inability to swallow is aphagia. In neurology, dysphagia is important because it may be the first sign of a brainstem lesion, bulbar palsy, pseudobulbar palsy, myasthenia gravis, Guillain–Barré syndrome, amyotrophic lateral sclerosis, or another dangerous disorder.

For the exam, the key is not only to list causes, but to decide:

Is the problem oropharyngeal and neurological, or esophageal and mainly gastrointestinal? Neurological dysphagia usually means difficulty initiating swallowing, choking, coughing, nasal regurgitation, wet voice, dysarthria, dysphonia, aspiration, or associated cranial nerve signs.

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