Videofluoroscopy and Swallowing Studies for Neurologic Disease: A Primer

Cine Studies

1. Normal swallow. VFSS cine, true lateral orientation, in a 27-year-old adult man swallowing thin liquid barium solution from a cup; note the efficiency of transit and timing.

2. Normal swallow. VFSS cine, true lateral orientation, in an 81-year-old man shows normal transit and timing (ie, age is not a factor).

3. Delayed swallow response in an 83-year-old male stroke patient. VFSS cine, true lateral orientation. The swallow response should trigger within 1 second of the head of the bolus reaching the ramus of the mandible as it crosses the tongue. Time it yourself.

4. Delayed swallow response in a 79-year-old male stroke patient. VFSS cine, true lateral orientation, shows frank aspiration; note contrast agent below the glottic folds and in the trachea.

5. Delayed swallow response in an 85-year-old male stroke patient. VFSS cine, true lateral orientation, shows reduced laryngeal closure and airway protection.

6. Lateral medullary (Wallenberg) syndrome in a 58-year-old man. VFSS cine, true lateral orientation, features reduced UES opening, or cricopharyngeal dysfunction. The reduction is best seen between C4 and C5 as the bolus passes.

7. Lateral medullary syndrome in an 87-year-old man. VFSS cine, anteroposterior orientation, shows penetration of contrast agent to the level of the vocal cords between the inverted triangular pyriform sinuses. Overt aspiration has not occurred.

8. Lateral medullary syndrome in an 87-year-old man. VFSS cine, anteroposterior orientation, shows characteristic asymmetry of residue. In this patient, there is more contrast agent pooling in the left pyriform sinus than in the right.

9. Lateral medullary syndrome in an 87-year-old man. VFSS cine, true lateral orientation, shows reduced UES opening contributing to increased aspiration during the course of swallows. A significant amount of contrast agent has been aspirated; note the posterior trachea below the cricoid cartilage.

10. Parkinson disease in a 75-year-old man. VFSS cine, true lateral orientation, shows disorganized lingual propulsion manifested as "tongue pumping," a classic finding in Parkinson disease.

11. Progressive supranuclear palsy in a 76-year-old man. VFSS cine, true lateral orientation, demonstrates that this patient has poor lingual control, loss of bolus control, and tongue protrusion.

12. Amyotrophic lateral sclerosis in a 63-year-old man. VFSS cine; true lateral orientation, shows that aspiration is present and is scored a 7 on the penetration/aspiration scale.

13. Amyotrophic lateral sclerosis in a 63-year-old man. VFSS cine, true lateral orientation, shows reduced pharyngeal propulsion, as demonstrated by the hypopharyngeal residue in the vallecula pyriforms and posterior pharynx.

14. Multiple sclerosis in a 66-year-old man. VFSS cine, true lateral orientation, indicates that this patient has altered sensations after swallowing; he points to his hyoid or vallecular area as the location where he feels residue. The still images show the tip of the patient's finger pointing to the hyoid bone.

15. Myotonic dystrophy in a 72-year-old man. VFSS cine, true lateral orientation, shows that the swallow is grossly abnormal; attempts are made at extra swallows to clear residue.

16. Oculopharyngeal muscular dystrophy in a 71-year-old man. VFSS cine, true lateral orientation, shows that this patient has difficulty clearing pharyngeal residue.

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