Name three common neurogenic causes of oropharyngeal dysphagia.

• A. Stroke, Parkinson disease, amyotrophic lateral sclerosis (ALS)
• B. GERD, peptic ulcer disease, gastritis
• C. Crohn disease, ulcerative colitis, diverticulitis
• D. Migraine, tension-type headache, cluster headache

Answer: (A)

Oropharyngeal dysphagia comes from problems with the neural control of the mouth and pharynx. When the brain or the motor neurons that drive the bulbar muscles are damaged, the swallow plan or the muscle contractions needed to move a bolus from the mouth into the throat are impaired, leading to difficulty initiating swallowing and a higher risk of aspiration.

Three classic neurogenic causes are those that disrupt this neural control: a stroke can injure the brain regions that coordinate the swallow, Parkinson disease causes slowed and poorly coordinated tongue and pharyngeal movements, and amyotrophic lateral sclerosis leads to progressive weakness of the bulbar muscles essential for the oral and pharyngeal phases of swallowing.

The other options involve non-neurologic or non-dysphagia-related GI conditions (reflux and mucosal diseases; inflammatory bowel diseases; primarily headache disorders). While they can cause swallowing difficulties in rare circumstances, they are not recognized as common neurogenic causes of oropharyngeal dysphagia.