# Pharyngeal High‐Resolution Manometry‐Based Evaluation of Dysphagia Recovery After Lateral Medullary Syndrome: A Case Series of Two Patients

## TL;DR

This paper presents two cases where pharyngeal high-resolution manometry helped assess and guide recovery from swallowing difficulties caused by a brainstem stroke.

## Contribution

The study demonstrates the utility of P-HRM-I in monitoring recovery and guiding treatment for neurogenic dysphagia.

## Key findings

- P-HRM-I revealed improved UES opening and pharyngeal function after treatment in both patients.
- Both patients regained sufficient swallowing function to return to a regular diet.
- P-HRM-I provided standardized and sensitive monitoring of therapeutic response.

## Abstract

To evaluate dysphagia, pharyngeal high‐resolution impedance manometry (P‐HRM‐I) is used in conjunction with videofluoroscopic examination of swallowing (VF) or videoendoscopic evaluation of swallowing to obtain additional objective data that cannot be captured by conventional assessment methods. Based on the Leuven Consensus of the International Pharyngeal Manometry Working Group for diagnosing pharyngeal and upper esophageal sphincter (UES) motility disorders, we present a case series of two patients illustrating the recovery process of dysphagia following lateral medullary syndrome. Two patients with severe dysphagia due to lateral medullary infarction caused by vertebral artery dissection were evaluated. In both patients, the initial P‐HRM‐I showed profound impairment of the UES opening and bolus passage, preventing oral intake. Balloon dilation of the UES, laryngeal elevation exercises, tongue strengthening exercises, and direct swallowing training were performed, and the functions of the pharynx and UES were regularly evaluated using VF and P‐HRM‐I. Following UES dilation, PHRM‐I revealed improved UES opening, enhanced pharyngeal contraction, and restoration of pharyngeal peristalsis. Both patients regained sufficient swallowing function to resume a regular diet. P‐HRM‐I may be a useful tool for quantitatively assessing UES function and bolus propulsion, identifying the pathophysiological components of dysphagia, guiding individualized treatment, and monitoring post‐intervention recovery.

Serial P‐HRM‐I assessments quantified UES dysfunction and pharyngeal motility recovery after lateral medullary syndrome. Guided by the Leuven Consensus, P‐HRM‐I provided standardized interpretation and, complementing VFSS, sensitively monitored therapeutic response and swallowing restoration in neurogenic dysphagia.