In several stroke survivors, swallowing improves over time, although in a sizeable minority dysphagia is longer lasting. All dysphagic patients, including those with temporary swallowing impairments, are at a substantial risk of developing pneumonia. This chapter reviews pertinent aspects of swallowing physiology, and the neuroanatomy and patterns of swallowing impairments with different stroke locations. The facial motor nucleus and its associated nerve control the labial and facial muscles and participate in the oral and pharyngeal phases of swallowing. Dysphagia is often apparent early after stroke onset and improves with time. It rarely occurs in isolation and is typically accompanied by other telltale signs of bulbar dysfunction such as dysarthria, facial weakness or numbness, impaired cough, or impairment of alertness. Dysphagia and aspiration in the lateral medullary syndrome usually occur with involvement of the rostral and dorsolateral parts of the medulla oblongata.

The advent of neuroimaging has allowed clinicians to improve clinico-anatomical correlations in stroke patients. Arterial trunks supplying the brainstem include: the vertebral artery, basilar artery, anterior and posterior spinal arteries, posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, posterior cerebral artery, and anterior choroidal artery. The arterial supply of the medulla oblongata comes from the vertebral arteries that form the middle rami of the lateral medullary fossa, the posterior inferior cerebellar artery that gives rise to the inferior rami of the lateral medullary fossa, and the anterior and posterior spinal arteries. Different arterial trunks supply blood to the pons, including the vertebral arteries, anterior inferior cerebellar artery, superior cerebellar artery, and basilar artery. The leptomeningeal arteries consist of the terminal branches of the anterior, middle, and posterior cerebral arteries forming an anastomotic network on the surface of the hemispheres.