Severe dysphagia occurs in over 50% of lateral medullary syndrome (LMS) cases, and the prognosis varies greatly among individuals. Predicting the prognosis of the dysphagia from data acquired at the acute phase is very important in selecting both the type and duration of dysphagia treatment. Here we examined whether radiological findings and severity of dysphagia in the acute phase could accurately predict prognosis and treatment required. We experienced 2 cases of LMS in which magnetic resonance imaging in the acute phase showed medullary lesions on the ipsilateral side of the medulla in each patient. Videofluorograhic examination of swallowing revealed severe dysphagia with an absence of the swallowing reflex. Both patients received swallowing therapy, including thermal stimulation, supraglottic swallow, and the Mendelsohn maneuver. While dysphagia was significantly improved one month post onset in one patient, the loss of swallowing reflex continued for more than one year in the other patient. These findings indicate that radiological data and severity of dysphagia in the acute phase cannot accurately predict the prognosis of dysphagia in LMS patients.
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