Dysphagia May Be an Independent Marker of Poor Outcome in Acute Lateral Medullary Infarction
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Background and Purpose Te functional recovery afer the lateral medullary infarction (LMI) is usually good. Little is known about the prognostic factors associated with poor outcome following acute LMI. Te aim of this study was to identify the factors associated with poor long-term outcome afer acute LMI, based on experiences at a single center over 11 years. Methods A consecutive series of 157 patients with acute LMI who were admitted within 7 days after symptom onset was evaluated retrospectively. Clinical symptoms were assessed within 1 day afer admission, and outcomes were evaluated over a 1-year period afer the initial event. Te lesions were classifed into three vertical types (rostral, middle, and caudal), and the patients were divided into two groups according to the outcome at 1 year: favorable [modifed Rankin Scale (mRS) score ≤1] and unfavorable (mRS score ≥2). Results Of the 157 patients, 93 (59.2%) had a favorable outcome. Older age, hypertension, dysphagia, requirement for intensive care, and pneumonia were signifcantly more prevalent in the unfavorable outcome group. The frequencies of intensive care (13%) and mortality (16.7%) were signifcantly higher in the rostral lesion (p=0.002 and p=0.002). Conditional logistic regression analysis revealed that older age and initial dysphagia were independently related to an unfavorable outcome at 1 year [odds ratio (OR)=1.04, 95% confdence interval (95% CI)=1.001–1.087, p=0.049; OR=2.46, 95% CI=1.04–5.84, p=0.041]. Conclusions Tese results suggest that older age and initial dysphagia in the acute phase are independent risk factors for poor long-term prognosis afer acute LMI.
Abstract
Background and Purpose Te functional recovery afer the lateral medullary infarction (LMI) is usually good. Little is known about the prognostic factors associated with poor outcome following acute LMI. Te aim of this study was to identify the factors associated with poor long-term outcome afer acute LMI, based on experiences at a single center over 11 years. Methods A consecutive series of 157 patients with acute LMI who were admitted within 7 days after symptom onset was evaluated retrospectively. Clinical symptoms were assessed within 1 day afer admission, and outcomes were evaluated over a 1-year period afer the initial event. Te lesions were classifed into three vertical types (rostral, middle, and caudal), and the patients were divided into two groups according to the outcome at 1 year: favorable [modifed Rankin Scale (mRS) score ≤1] and unfavorable (mRS score ≥2). Results Of the 157 patients, 93 (59.2%) had a favorable outcome. Older age, hypertension, dysphagia, requirement for intensive care, and pneumonia were signifcantly more prevalent in the unfavorable outcome group. The frequencies of intensive care (13%) and mortality (16.7%) were signifcantly higher in the rostral lesion (p=0.002 and p=0.002). Conditional logistic regression analysis revealed that older age and initial dysphagia were independently related to an unfavorable outcome at 1 year [odds ratio (OR)=1.04, 95% confdence interval (95% CI)=1.001–1.087, p=0.049; OR=2.46, 95% CI=1.04–5.84, p=0.041]. Conclusions Tese results suggest that older age and initial dysphagia in the acute phase are independent risk factors for poor long-term prognosis afer acute LMI.
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