Swallowing musculature is asymmetrically represented in both motor cortices. Stroke affecting the hemisphere with the dominant swallowing projection results in dysphagia and clinical recovery has been correlated with compensatory changes in the previously non-dominant, unaffected hemisphere. This asymmetric bilaterality may explain why up to half of stroke patients are dysphagic and why many will regain a safe swallow over a comparatively short period. Despite this propensity for recovery, dysphagia carries a sevenfold increased risk of aspiration pneumonia and is an independent predictor of mortality. The identification, clinical course, pathophysiology, and treatment of dysphagia after stroke are discussed in this review.
- VFS, videofluoroscopy
- FEES, fibreoptic endoscopic evaluation of swallowing
- PEG, precutaneous endoscopic gastrostomy
- TMS, transcranial magnetic stimulation
- EMG, electromyography
- NG, nasogastric
- aspiration pneumonia
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Competing interests: SS is a clinical research fellow employed by Manchester University through grants from The Health Foundation and the Medical Research Council. SH is a lecturer at Manchester University and honorary consultant Gastroenterologist at Hope Hospital, Salford. Neither author has any competing interests to declare.