Department of Neurology, University of Muenster, Albert-Schweitzer-Str.33, 48149 Muenster, Germany.
J Neurol. 2012 Jan;259(1):93-9. doi: 10.1007/s00415-011-6129-3. Epub 2011 Jun 7.
Dysphagia is found in up to 80% of acute stroke patients. To date most studies have focused on ischemic stroke only. Little is known about the incidence and pattern of dysphagia in hemorrhagic stroke. Here we describe the characteristics of dysphagia in patients with striatocapsular hemorrhage. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was carried out in 30 patients with acute striatocapsular hemorrhage. Dysphagia was classified according to the six-point Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) within 72 h after admission. Lesion volume, hemisphere and occurrence of ventricular rupture were determined from computer tomography scans. Data on initial NIH-SS, clinical symptoms, need for endotracheal intubation, diagnosis of pneumonia and feeding status on discharge were recorded. Swallowing impairment was observed in 76.7% of patients (n = 23). Mean FEDSS score was 3.1 ± 1.5. Main findings were penetration or aspiration of liquids as well as leakage to valleculae and piriform sinus. Incidence of pneumonia was 30.0% (n = 9). Age, NIH-SS and hematoma volume did not correlate with dysphagia severity. None of the clinical characteristics was predictive for dysphagia. On discharge after 12.9 ± 5.3 days, a two-point improvement on the FEDSS was seen in seven patients, (30.4%) and five patients (21.7%) had gained at least one point. In striatocapsular hemorrhage, dysphagia is a common and so far underrecognized symptom. FEES results indicate predominant impairment of oral motor control. Swallowing impairment is not related to other clinical deficits, stroke severity or lesion characteristics. Thus, detailed dysphagia assessment is indicated in all cases.
吞咽障碍在多达 80%的急性脑卒中患者中存在。迄今为止，大多数研究仅集中在缺血性脑卒中。关于出血性脑卒中吞咽障碍的发生率和模式知之甚少。在这里，我们描述了纹状体-壳核出血患者吞咽障碍的特征。对 30 例急性纹状体-壳核出血患者进行了纤维内镜吞咽评估（FEES）。在入院后 72 小时内，根据六点纤维内镜吞咽障碍严重程度量表（FEDSS）对吞咽障碍进行分类。从计算机断层扫描确定病变体积、半球和脑室破裂的发生。记录初始 NIH-SS、临床症状、是否需要气管插管、肺炎诊断和出院时的喂养状态。76.7%的患者（n=23）存在吞咽障碍。平均 FEDSS 评分为 3.1±1.5。主要发现是液体的渗透或吸入，以及向会厌谷和梨状窦泄漏。肺炎的发生率为 30.0%（n=9）。年龄、NIH-SS 和血肿体积与吞咽障碍严重程度无关。没有任何临床特征可预测吞咽障碍。在出院时（12.9±5.3 天后），7 名患者（30.4%）FEDSS 评分改善了 2 分，5 名患者（21.7%）至少增加了 1 分。在纹状体-壳核出血中，吞咽障碍是一种常见且迄今为止被低估的症状。FEES 结果表明口腔运动控制受损明显。吞咽障碍与其他临床缺陷、卒中严重程度或病变特征无关。因此，所有病例均需要进行详细的吞咽障碍评估。
