뇌졸중 병변에 따른 삼킴장애의 양상
Dysphagia Pattern according to Stroke Location
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초록
Objective: To investigate the pattern of dysphagia according to the location of brain lesions. Method: Two hundred and seventy two patients with post-stroke dysphagia underwent a Videofluoroscopic Swallowing Study (VFSS). The brain lesions were classified into infarction and hemorrhage by brain MRI or CT findings, and the location of the brain lesions was subdivided into right and left hemisphere (cortical and subcortical), brainstem, and cerebellum. The dysphagia pattern was analyzed according to stroke location. Result: Patients with left hemispheric or cerebellar stroke showed more frequent abnormal coordination of oral transfer (P＜0.05). Delayed pharyngeal swallowing was seen more frequently in patients with stroke of the left hemisphere and brainstem (P＜0.05). In patients with brainstem or cerebellar stroke, the range of laryngeal excursion was smaller and the bolus retentions in vallecular and piriform sinues were larger than hemispheric stroke. (P＜0.05). Pharyngeal motility was reduced in patients with brainstem or cerebellar lesions. Patients with brainstem stroke had a higher incidence of upper esophageal sphincter dysfunction (P＜0.05). Conclusion: The pattern of dysphagia can be predicted by stroke location, and it will be of beneficial to make therapeutic plans for reducing complications from dysphagia.
Abstract
Objective: To investigate the pattern of dysphagia according to the location of brain lesions. Method: Two hundred and seventy two patients with post-stroke dysphagia underwent a Videofluoroscopic Swallowing Study (VFSS). The brain lesions were classified into infarction and hemorrhage by brain MRI or CT findings, and the location of the brain lesions was subdivided into right and left hemisphere (cortical and subcortical), brainstem, and cerebellum. The dysphagia pattern was analyzed according to stroke location. Result: Patients with left hemispheric or cerebellar stroke showed more frequent abnormal coordination of oral transfer (P＜0.05). Delayed pharyngeal swallowing was seen more frequently in patients with stroke of the left hemisphere and brainstem (P＜0.05). In patients with brainstem or cerebellar stroke, the range of laryngeal excursion was smaller and the bolus retentions in vallecular and piriform sinues were larger than hemispheric stroke. (P＜0.05). Pharyngeal motility was reduced in patients with brainstem or cerebellar lesions. Patients with brainstem stroke had a higher incidence of upper esophageal sphincter dysfunction (P＜0.05). Conclusion: The pattern of dysphagia can be predicted by stroke location, and it will be of beneficial to make therapeutic plans for reducing complications from dysphagia.
참고문헌 (26)
- Park CI, "Rehabilitation", pp.389~402 (2007), Hanmibook
- Horner J, "Aspiration in bilateral stroke patients", Neuorology, 38, pp.1686~1688 (1990)
- Kwon MS, "Dysphagia in unilateral medullary infarction: lateral vs. medial lesions", Neurology, 65, pp.714~718 (2005)
- Albert MJ, "Aspiration after stroke : lesion analysis by brain MRI", Dysphagia, 7, pp.170~173 (1992)
- Yoon HS, "Clinical survey of dysphagia in stroke", J Korean Acad Rehab Med, 14, pp.196~202 (1990)
- Han TR, "The functional dysphagia scale using videofluoroscopic swallowing study in stroke patients", J Korean Acad Rehab Med, 23, pp.1118~1126 (1999)
- 이청기, "뇌졸증 환자에서 뇌 병변 위치에 따른 연하곤란의 양상", Annals of Rehabilitation Medicine, 25(2), pp.193~201 (2001), 대한재활의학회
- Logemann JA, "Manual for the viedofluorographic study of swallowing", pp.74~114 (1993), Pro-ed
- Martin RE, "The role of the cerebral cortex in swallowing", Dysphagia, 8, pp.195~202 (1993)
- Miller AJ, "The search for the central swallowing pathway : The quest for clarity", Dysphagia, 8, pp.185~194 (1993)
- Daniels SK, "Lesion location in acute stroke patients with risk of aspiration", J Neuroimaging, 9, pp.91~98 (1999)
- Hendrix TR, "Art and science of history taking in the patient with difficulty swallowing", Dysphagia, 8, pp.69~73 (1993)
- Robbins J, "Swallowing after unilateral stroke of the cerebral cortex : preliminary evidence", Dysphagia, 3, pp.11~17 (1988)
- Robbins J, "Swallowing after unilateral stroke of the cerebral cortex", Arch Phys Med Rehabil, 74, pp.1295~1300 (1993)
- Cola MG, "Relevance of subcortical stroke in dysphagia", Stroke, 41, pp.482~486 (2010)
- Steinhagen V, "Swallowing disturbance pattern relates to brain lesion location in acute stroke patients", Stroke, 40, pp.1903~1906 (2009)
- Kim H, "Aspiration subsequent to a pure medullary infarction : lesion sites, clinical variables, and outcome", Arch Neurol, 57, pp.478~483 (2000)
- Kwon M, "Dysphagia in unilateral medullary infarction : lateral vs medial lesions", Neurology, 65, pp.714~718 (2005)
- Bian RX, "Impaired opening of the upper esophageal sphincter in patients with medullary infarctions", Dysphagia, 24, pp.238~245 (2009)
- Celifarco A, "Dysphagia as the sole manifestation of bilateral strokes", Am J Gastroenterol, 85, pp.610~613 (1990)
- Teasell RW, "Prevalence and recovery of aspiration poststroke : a retrospective analysis", Dysphagia, 9, pp.35~39 (1994)
- Daniels SK, "The role of the insular cortex in dysphagia", Dysphagia, 12, pp.146~156 (1997)
- Riecker A, "Dysphagia due to unilateral infarction in the vascular territory of the anterior insula", Dysphagia, 24, pp.114~118 (2009)
- Horner J, "Silent aspiration following stroke", Neurology, 38, pp.317~319 (1988)
- Hamdy S, "Explaining oropharyngeal dysphagia after unilateral hemispheric stroke", Lancet, 350, pp.686~692 (1997)
- Smithard DG, "Complications and outcome after acute stroke. does dysphagia matter?", Stroke, 27, pp.1200~1204 (1996)