Characteristics and Risk Factors of Aspiration in Lateral Medullary Infarction
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective: To evaluate the characteristics of dysphagia and identify the risk factors of bolus aspiration in patientspresenting with pure lateral medullary infarction (LMI). Methods: Between January 2014 and January 2019, 51 post-stroke patients with LMI who underwent a videofluoroscopicswallowing study (VFSS) were enrolled retrospectively, and their medical records and brain magnetic resonanceimaging results were reviewed. The VFSS results were evaluated to analyze the swallowing function using thepenetration-aspiration scale, functional dysphagia scale, and imaging analysis software. Results: Bolus aspiration was detected in 21 patients (41.2%). The common abnormal VFSS findings were residue invalleculae (74.5%), delayed triggering of pharyngeal swallow (72.5%), residue in pyriform sinuses (62.7%), delayed pharyngealtransit time (56.9%), reduced laryngeal elevation (51.0%), and coating of the pharyngeal wall (49.0%). Theincidence of aspiration was significantly higher in the typical lesions (including the diagonal band-shaped lesions)and the large type lesions extending ventrally or dorsally, as compared to other lesion types (P＜0.05). Logistic regressionanalyses revealed that the residue in pyriform sinuses is a significant independent risk factor of aspirationin the puree trial, and prolonged pharyngeal delay time (PDT) and residue in valleculae are significant risk factorsin the thin liquid trial (P＜0.05). Conclusion: Considering all clinical factors, lesion locations, and swallowing processes, results of the current studyindicate that residue in pyriform sinuses is an independent risk factor of aspiration in the swallowing puree technique,whereas prolonged PDT and residue in valleculae are independent risk factors of aspiration in the swallowingliquid technique.
Abstract
Objective: To evaluate the characteristics of dysphagia and identify the risk factors of bolus aspiration in patientspresenting with pure lateral medullary infarction (LMI). Methods: Between January 2014 and January 2019, 51 post-stroke patients with LMI who underwent a videofluoroscopicswallowing study (VFSS) were enrolled retrospectively, and their medical records and brain magnetic resonanceimaging results were reviewed. The VFSS results were evaluated to analyze the swallowing function using thepenetration-aspiration scale, functional dysphagia scale, and imaging analysis software. Results: Bolus aspiration was detected in 21 patients (41.2%). The common abnormal VFSS findings were residue invalleculae (74.5%), delayed triggering of pharyngeal swallow (72.5%), residue in pyriform sinuses (62.7%), delayed pharyngealtransit time (56.9%), reduced laryngeal elevation (51.0%), and coating of the pharyngeal wall (49.0%). Theincidence of aspiration was significantly higher in the typical lesions (including the diagonal band-shaped lesions)and the large type lesions extending ventrally or dorsally, as compared to other lesion types (P＜0.05). Logistic regressionanalyses revealed that the residue in pyriform sinuses is a significant independent risk factor of aspirationin the puree trial, and prolonged pharyngeal delay time (PDT) and residue in valleculae are significant risk factorsin the thin liquid trial (P＜0.05). Conclusion: Considering all clinical factors, lesion locations, and swallowing processes, results of the current studyindicate that residue in pyriform sinuses is an independent risk factor of aspiration in the swallowing puree technique,whereas prolonged PDT and residue in valleculae are independent risk factors of aspiration in the swallowingliquid technique.
참고문헌 (41)
- Smithard DG, "The natural history of dysphagia following a stroke", Dysphagia, 12, pp.188~193 (1997)
- Inoue M, "The neural mechanisms underlying swallowing", Brain Nerve, 67, pp.157~168 (2015)
- Kameda W, "Lateral and medial medullary infarction : a comparative analysis of 214 patients", Stroke, 35, pp.694~699 (2004)
- Currier RD, "Some comments on Wallenberg’s lateral medullary syndrome", Neurology, 11, pp.778~791 (1961)
- Aydogdu I, "Dysphagia in lateral medullary infarction (Wallenberg’s syndrome): an acute disconnection syndrome in premotor neurons related to swallowing activity?", Stroke, 32, pp.2081~2087 (2001)
- Martino R, "Dysphagia in a patient with lateral medullary syndrome : insight into the central control of swallowing", Gastroenterology, 121, pp.420~426 (2001)
- Oshima F, "Prediction of dysphagia severity : an investigation of the dysphagia patterns in patients with lateral medullary infarction", Intern Med, 52, pp.1325~1331 (2013)
- Arenaz Bua B, "Treatment of cricopharyngeal dysfunction : a comparative pilot study", BMC Res Notes, 8, pp.301~ (2015)
- Bian RX, "Impaired opening of the upper esophageal sphincter in patients with medullary infarctions", Dysphagia, 24, pp.238~245 (2009)
- Nakao M, "Disruption of the Obligatory Swallowing Sequence in Patients with Wallenberg Syndrome", Dysphagia (2019)
- Kwon M, "Dysphagia in unilateral medullary infarction : lateral vs medial lesions", Neurology, 65, pp.714~718 (2005)
- Kim JS, "Pure lateral medullary infarction: clinical-radiological correlation of 130 acute, consecutive patients", Brain, 126, pp.1864~1872 (2003)
- Kim JS, "Spectrum of lateral medullary syndrome. Correlation between clinical findings and magnetic resonance imaging in 33 subjects", Stroke, 25, pp.1405~1410 (1994)
- Kim J, "Validation of the videofluoroscopic dysphagia scale in various etiologies", Dysphagia, 29, pp.438~443 (2014)
- Han TR, "Quantifying swallowing function after stroke : A functional dysphagia scale based on videofluoroscopic studies", Arch Phys Med Rehabil, 82, pp.677~682 (2001)
- Rosenbek JC, "A penetration-aspiration scale", Dysphagia, 11, pp.93~98 (1996)
- Soo Jin Jung, "Rick Factors Associated with Aspiration in Patients with Head and Neck Cancer", Annals of Rehabilitation Medicine, 35(6), pp.781~790 (2011), 대한재활의학회
- Cichero JA, "Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management : The IDDSI Framework", Dysphagia, 32, pp.293~314 (2017)
- Vuilleumier P, "Infarction of the lower brainstem. Clinical, aetiological and MRI-topographical correlations", Brain, 118(Pt 4), pp.1013~1025 (1995)
- Kim JS, "Patterns of lateral medullary infarction : vascular lesion-magnetic resonance imaging correlation of 34 cases", Stroke, 29, pp.645~652 (1998)
- Hong YH, "Lesion Topography and Its Correlation With Etiology in Medullary Infarction : Analysis From a Multi-Center Stroke Study in China", Front Neurol, 9, pp.813~ (2018)
- Cabre M, "Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia", Age Ageing, 39, pp.39~45 (2010)
- Clave P, "Pathophysiology, relevance and natural history of oropharyngeal dysphagia among older people", Nestle Nutr Inst Workshop Ser, 72, pp.57~66 (2012)
- Loeb MB, "Interventions to prevent aspiration pneumonia in older adults : a systematic review", J Am Geriatr Soc, 51, pp.1018~1022 (2003)
- Cho YJ, "Which Factors Affect the Severity of Dysphagia in Lateral Medullary Infarction?", Dysphagia (2019)
- Jardine M, "Swallowing function in advanced age", Curr Opin Otolaryngol Head Neck Surg, 26, pp.367~374 (2018)
- Ogawa K, "Clinical study of 46 patients with lateral medullary infarction", J Stroke Cerebrovasc Dis, 24, pp.1065~1074 (2015)
- Ye Q, "Effect of electro-acupuncture on regulating the swallowing by activating the interneuron in ventrolateral medulla(VLM)", Brain Res Bull, 144, pp.132~139 (2019)
- Robbins J, "Swallowing after unilateral stroke of the cerebral cortex", Arch Phys Med Rehabil, 74, pp.1295~1300 (1993)
- Power ML, "Predicting aspiration after hemispheric stroke from timing measures of oropharyngeal bolus flow and laryngeal closure", Dysphagia, 24, pp.257~264 (2009)
- Daniels SK, "Lesion localization in acute stroke patients with risk of aspiration", J Neuroimaging, 9, pp.91~98 (1999)
- 박정미, "Cutoff Value of Pharyngeal Residue in Prognosis Prediction After Neuromuscular Electrical Stimulation Therapy for Dysphagia in Subacute Stroke Patients", Annals of Rehabilitation Medicine, 38(5), pp.612~619 (2014), 대한재활의학회
- Perlman AL, "The relationship of vallecular residue to oral involvement, reduced hyoid elevation, and epiglottic function", J Speech Hear Res, 35, pp.734~741 (1992)
- Bingjie L, "Quantitative videofluoroscopic analysis of penetration-aspiration in post-stroke patients", Neurol India, 58, pp.42~47 (2010)
- Molfenter SM, "Kinematic and temporal factors associated with penetration-aspiration in swallowing liquids", Dysphagia, 29, pp.269~276 (2014)
- Higo R, "Manometric abnormality in dysphagic patients after medullary cerebrovascular accidents", ORL J Otorhinolaryngol Relat Spec, 64, pp.368~372 (2002)
- Newman R, "Effect of Bolus Viscosity on the Safety and Efficacy of Swallowing and the Kinematics of the Swallow Response in Patients with Oropharyngeal Dysphagia : White Paper by the European Society for Swallowing Disorders(ESSD)", Dysphagia, 31, pp.232~249 (2016)
- Rofes L, "The volume-viscosity swallow test for clinical screening of dysphagia and aspiration", Nestle Nutr Inst Workshop Ser, 72, pp.33~42 (2012)
- Sia I, "Bolus volume and viscosity effects on pharyngeal swallowing power-How physiological bolus accommodation affects bolus dynamics", Neurogastroenterol Motil, 30, pp.e13481~ (2018)
- Dantas RO, "Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing", Am J Physiol, 258, pp.G675~681 (1990)
- Wu S, "Effect of Changes in Bolus Viscosity on Swallowing Muscles in Patients with Dysphagia after Stroke", Chin Med J(Engl), 131, pp.2868~2870 (2018)