Moriwaki Misa, Hase Hitoshi, Fujioka Seiji, Yonekura Noriko, Katao Naoko, Takahashi Kazuhiro, Mori Masaki, Koyama Tetsuo, Domen Kazuhisa
Department of Rehabilitation Medicine, Midorigaoka Hospital, 3-13-1 Makami-cho, Takatsuki, Osaka 569-1121, Japan.
Spine Center, Midorigaoka Hospital, 3-13-1 Makami-cho, Takatsuki, Osaka 569-1121, Japan.
NMC Case Rep J. 2016 May 19;3(3):75-79. doi: 10.2176/nmccrj.cr.2016-0024. eCollection 2016 Jul.
A 79-year-old man was diagnosed with left thalamic hemorrhage. On admission, the Functional Independence Measure (FIM) motor score was 13 points, and the Food Intake Level Scale (FILS) was Level 2, with the patient needing enteral nutrition. Six months after stroke onset, the FIM motor score had improved to 38 points and the dysphagia to FILS Level 7. The patient was able to ingest easy-to-swallow food orally three times a day, but only after postural adjustment with rotation of the head. Seven months after stroke onset, the FIM motor score had reached 45 points but without further improvement in swallowing function. Videofluoroscopic swallowing evaluation (VF) revealed that the persistence of dysphagia was due to osteophytes on the cervical vertebrae caused by diffuse idiopathic skeletal hyperostosis. On surgical removal of the osteophytes, swallowing function improved to FILS Level 9; the patient was able to ingest normal food in a seated position without postural adjustment. One year after stroke onset, the patient was discharged with an FIM motor score of 59 points and FILS Level 9. At the 2-year follow-up, there was minimal recurrence of the osteophytes, and both motor and swallowing functions were maintained at the same level as at discharge. This case suggests that dysphagia in elderly patients may be due to multiple disorders, and that surgical intervention may occasionally be effective.
一名79岁男性被诊断为左侧丘脑出血。入院时，功能独立性测量（FIM）运动评分为13分，食物摄入水平量表（FILS）为2级，患者需要肠内营养。脑卒中发病6个月后，FIM运动评分提高到38分，吞咽困难改善至FILS 7级。患者能够每天口服三次易于吞咽的食物，但仅在头部旋转进行姿势调整后才行。脑卒中发病7个月后，FIM运动评分达到45分，但吞咽功能未进一步改善。电视荧光吞咽评估（VF）显示，吞咽困难持续存在是由于弥漫性特发性骨肥厚导致颈椎骨赘形成。手术切除骨赘后，吞咽功能改善至FILS 9级；患者能够在坐位无需姿势调整的情况下摄入正常食物。脑卒中发病1年后，患者出院时FIM运动评分为59分，FILS为9级。在2年随访时，骨赘复发极少，运动和吞咽功能均维持在出院时的水平。该病例表明，老年患者的吞咽困难可能由多种疾病引起，手术干预偶尔可能有效。
