A site for medical students - Practical,Theory,Osce Notes

What are the causes of motor (neuromuscular) Dysphagia

I. Difficulty in initiating swallowing reflex
A. Paralysis of the tongue
B. Oropharyngeal anaesthesia
C. Lack of saliva (e.g., Sjogren's syndrome)
D. Lesions of sensory components of vagus and glossopharyngeal nerves
E. Lesions of swallowing center
II. Disorders of pharyngeal and esophageal striated muscle
A. Muscle weakness
1.UMN – pseudo bulbar pabv
2. Lower motor neuron lesion (bulbar paralysis)
  • Motor neuron disease
  • Poliomyelitis, postpolio syndrome
  • Polyneuritis
  • Amyotrophic lateral sclerosis
  • Familial dysautonomia
3. Neuromuscular
   Myasthenia gravis
4. Muscle disorders
  • Polymyositis
  • Dermatomvositis
  • Myopathies (myotonic dystrophy, oculopharyngeal myopathy)
B. Nonperistaltic contractions or impaired deglutitive inhibition
1. Pharynx and upper oesophagus
  • Rabies
  • Tetanus
  • Extrapyramidal tract disease
  • Upper motor neuron lesions (pseudobulbar paralysis)
2. Upper oesophageal sphincter (UES)
  •   Paralysis of suprahyoid muscles (causes same as paralysis of pharyngeal musculature)
  •   Cricopharyngeal achalasia
III. Disorders of oesophageal smooth muscle
A. Paralysis of oesophageal body causing weak contractions
  • Scleroderma and related collagen-vascular diseases
  • Hollow visceral myopathy
  • Myotonic dystrophy
  • Metabolic neuromyopathy (amyloid, alcohol diabetes?)
  • Achalasia (classical)
B. Nonperistaltic contractions or impaired deglutitive inhibition
1. Oesophageal body
  • Diffuse oesophageal spasm
  • Achalasia (vigorous)
  • Variants of diffuse oesophageal spasm
2. Lower oesophageal sphincter
A. Achalasiano
1. Primary
2. Secondary
  • Chagas' disease
  • Carcinoma
  • Lymphoma
  • Neuropathic intestinal pseudoobstruction syndrome
  • Toxins and drugs
В. Lower oesophageal muscular (contractile) ring

Common causes of Motor Dysphagia 
  • Motor neuron disease
  • Progressive bulbar palsy
  • Pseudobulbar palsy
  • Myasthenia gravis
  • Myotonic dystrophy
  • Polymyositis
  •  Oculopharyngeal myopathy.