Post-Stroke Dysphagia – Instrumental Assessment — SCE Neurology MCQ

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ModerateNeurorehabilitationPost-Stroke Dysphagia – Instrumental AssessmentSCE Neurology

A 60-year-old man with a recent right MCA territory stroke has persistent difficulty swallowing. He aspirates on thin liquids but manages thickened fluids safely. He is on a modified texture diet. He is 3 weeks post-stroke and swallowing has not improved. What specialist assessment should be arranged?

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Correct answer: A — Fibreoptic endoscopic evaluation of swallowing (FEES) or videofluoroscopy

Instrumental swallowing assessment — either FEES (fibreoptic endoscopic evaluation of swallowing) or videofluoroscopy (VFS) — is recommended for patients with persistent dysphagia following stroke to guide dietary texture modifications and identify silent aspiration. FEES allows direct visualisation of the pharyngeal and laryngeal structures during swallowing. VFS provides dynamic imaging of the entire swallowing process. A: Barium swallow is less informative than VFS for neurogenic dysphagia. C: CT neck is for structural pathology. D: OGD assesses the oesophagus. E: Laryngoscopy alone does not assess the swallowing mechanism.

Reference: RCP National Clinical Guideline for Stroke (2023); NICE CG162