외측연수경색 환자에서의 연하장애의 비디오 투시 검사상의 특성: 중뇌동맥영역과 비교하여

Abstract

B a c k g ro u n d: Although swallowing dysfunction is a major disabling impairment in patients with lateral medullary infarction, few studies have been undertaken to identify the precise mechanism of their dysphagia. The present study was conducted to investigate the differences in swallow physiology between patients with lateral medullary infarction and those with middle cerebral artery (MCA) territory infarction. Methods: Retrospective analysis of videofluoroscopic study was performed in 12 patients with lateral medullary infarction (LMI group) and 14 patients with MCA infarction (MCA group). Time variables including oral transit time, pharyngeal delay time, and pharyngeal transit time were compared between both groups. Pharyngeal residues in vallecullar and pyriform sinus after swallowing, the frequency of aspiration, and relaxation of upper esophageal sphincter (UES) were also compared. Results: The frequency of aspiration and impaired UES relaxation were found to be significantly higher in LMI group than in MCA group (p<0.05). Pharyngeal transit time was found to be greater in LMI group than in MCA group (p<0.04), whereas no differences in oral transit time and pharyngeal delay time were found between the two groups. In terms of pharyngeal residues, LMI group seemed to show more abundant residues in piryform sinus than in MCA group. However, no difference in vallecular residue was found between the two groups. Coclusion: These findings suggest that impaired UES relaxation might result in slow pharyngealtransit of food and excessive residue in pyriform sinus, and these might also induce overflow aspiration in patients with lateral medullary infarction. (Korean Journal of Stroke 2005;7(2): 186~190)