Magnetic resonance imaging for evaluating neurogenic dysphagia

Dysphagia due to CNS pathology usually stems from one of two patterns of disease: (1) bilateral corticobulbar tract dysfunction (“pseudobulbar palsy”) or (2) pontomedullary dysfunction (“bulbar palsy”). Computed tomography (CT) has proved to be useful for evaluating the brainstem in patients with neurogenic dysphagia. Nonetheless, artifacts are common in CT imaging of the posterior fossa. Also, direct sagittal imaging is not usually obtainable by CT in adult patients. Magnetic resonance imaging (MRI), in contrast to CT, simultaneously gathers sequential images in the same plane and can obtain direct reconstructions in any plane of interest. MRI has proven to be more sensitive than CT in demonstrating lesions of the brain, such as demyelinating (e.g., multiple sclerosis) and ischemic diseases, (Brant-Zawadzki et al. 1984, Bradley et al. 1984, Bydder et al. 1982, Sheldon et al. 1985) as well as neoplastic masses that may produce neurogenic dysphagia (Lee et al. 1985, Zimmerman et al. 1986). Five patients with dysphagia are reported for whom MRI was valuable in detecting and characterizing their lesions of the brainstem and the cerebral hemispheres.