ABSTRACT
The causes of dysphagia may be classified into neuromuscular and obstructive categories. Disruption of the neuromuscular control of swallowing may occur at the level of the central nervous system, the peripheral nerves or the pharyngeal and oesophageal muscles. Patients with neuromuscular dysphagia may be at risk of aspiration if they are allowed unrestricted oral intake. Examination of the mouth and pharynx should not be performed without anaesthetic support and full resuscitation facilities if airway compromise is a possibility, as it may precipitate complete airway occlusion. Hemiparesis, hemisensory loss, dysphasia, dyspraxia, visual neglect or homonymous hemianopia suggest a cerebral lesion. Abnormal, uncoordinated or involuntary movement may occur with degenerative, demyelinating or inherited disorders of the central nervous system. Bulbar palsy is characterised by nasal speech, tongue wasting and fasciculation, and an absent gag reflex. Pseudobulbar palsy is char-acterised by spastic dysarthria, a brisk gag reflex and jaw jerk, and emotional lability.
