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Table 3 Endoscopic phenotypes of neurogenic dysphagia [65]

From: Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Main findings Neurological diseases
Peripheral Central
I) Premature spillage Early-stage ALS Early-stage ALS, early-stage PSP, frontotemporal dementia, SPG7-HSP, acute stroke*
II) Delayed swallow reflex   Acute stroke*
III) Impaired pharyngeal bolus clearance (residue in valleculae >>> residue in piriform sinus) Bulbospinal muscular atrophy, myotonic dystrophy type II, (critical illness neuropathy/myopathy,) early stage ALS Early ALS, early-stage PD
IV) Impaired opening of upper oesophageal sphincter (residue in piriform sinus >>> residue in valleculae) Inclusion body myositis (IBM) Dorsolateral medulla oblongata infarction
V) Complex pathology (combination of I-IV, at least 2 equivalent patterns) Severe myasthenia gravis, end-stage ALS, (GBS), myotonic dystrophy type I End-stage ALS, advanced stages of PD and PSP
VI) Extrapyramidal motor impairment (one out of I-IV) plus movement disorder Neuroleptic-induced dysphagia, PD, MSA, Huntington’s disease
VII) Fatigable oropharyngeal dysphagia (one out of I-IV plus swallowing fatigability) Myasthenia gravis (PD, ALS)
  1. *All stroke locations apart from strokes confined to the dorsolateral medulla oblongata