Steinhagen Volker, Grossmann Annette, Benecke Reiner, Walter Uwe
Department of Neurology, University of Rostock, Rostock, Germany.
Stroke. 2009 May;40(5):1903-6. doi: 10.1161/STROKEAHA.108.535468. Epub 2009 Mar 12.
The relationship of brain lesion location and swallowing disturbance pattern has been poorly studied in acute stroke patients.
Sixty patients with first-ever acute ischemic stroke at clearly assessed location and clinical signs of dysphagia were studied. Swallowing-related parameters rated clinically and fiberendoscopically were attention deficit, buccofacial apraxia, orofacial paresis, gag reflex, delay of pharyngeal swallow, pharyngeal contraction, larynx elevation, function of upper esophageal sphincter (UES), and aspiration severity.
Attention deficit was independently predicted only by parietotemporal infarction, buccofacial apraxia by left-sided parietotemporal infarction, orofacial paresis by infarction encompassing upper motor neuron of cranial nerves, and impaired UES opening by lateral medullary infarction. Other swallowing parameters were not related to lesion topology. On posthoc analysis, pneumonia within 21 days after stroke was predicted only by insular lesion.
Distinct acute brain lesion locations result in characteristic swallowing disturbance patterns. Dysphagic patients with insular stroke appear to have even higher risk of pneumonia suggesting a further associated factor promoting infection in these subjects.
急性脑卒中患者脑损伤部位与吞咽障碍模式之间的关系鲜有研究。
对60例首次发生急性缺血性脑卒中且损伤部位明确、有吞咽困难临床体征的患者进行研究。通过临床评估和纤维内镜检查评定的吞咽相关参数包括注意力缺陷、口面部失用、口面部轻瘫、咽反射、咽吞咽延迟、咽收缩、喉上抬、食管上括约肌（UES）功能及误吸严重程度。
仅顶颞叶梗死可独立预测注意力缺陷，左侧顶颞叶梗死可预测口面部失用，累及脑神经上运动神经元的梗死可预测口面部轻瘫，延髓外侧梗死可预测UES开放受损。其他吞咽参数与病变拓扑结构无关。事后分析显示，仅岛叶病变可预测卒中后21天内发生肺炎。
不同的急性脑损伤部位会导致特征性的吞咽障碍模式。岛叶卒中的吞咽困难患者发生肺炎的风险似乎更高，提示这些患者存在促进感染的其他相关因素。
