Marian Thomas, Schröder Jens Burchard, Muhle Paul, Claus Inga, Riecker Axel, Warnecke Tobias, Suntrup-Krueger Sonja, Dziewas Rainer
Department of Neurology, University Hospital Münster, Münster, Germany.
Neurological/Neurosurgical Rehabilitation Clinic, RehaNova, Cologne, Germany.
Cerebrovasc Dis Extra. 2017;7(3):130-139. doi: 10.1159/000479483. Epub 2017 Oct 3.
Dysphagia is a frequent and dangerous complication of acute stroke. Apart from a well-timed oropharyngeal muscular contraction pattern, sensory feedback is of utmost importance for safe and efficient swallowing. In the present study, we therefore analyzed the relation between pharyngolaryngeal sensory deficits and post-stroke dysphagia (PSD) severity in a cohort of acute stroke patients with middle cerebral artery (MCA) infarction.
Eighty-four first-ever MCA stroke patients (41 left, 43 right) were included in this trial. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardized protocol within 96 h after stroke onset. PSD was classified according to the 6-point fiberoptic endoscopic dysphagia severity scale. Pharyngolaryngeal sensation was semi-quantitatively evaluated by a FEES-based touch technique.
PSD severity was closely related to the pharyngolaryngeal sensory deficit. With regards to lateralization of the sensory deficit, there was a slight but significant preponderance of sensory loss contralateral to the side of stroke. Apart from that, right hemispheric stroke patients were found to present with a more severe PSD.
This study provides evidence that an intact sensory feedback is of utmost importance to perform nonimpaired swallowing and highlights the key role of disturbed pharyngeal and laryngeal afferents in the pathophysiology of PSD.
吞咽困难是急性中风常见且危险的并发症。除了适时的口咽肌肉收缩模式外，感觉反馈对于安全有效的吞咽至关重要。因此，在本研究中，我们分析了一组大脑中动脉（MCA）梗死的急性中风患者的咽喉感觉缺陷与中风后吞咽困难（PSD）严重程度之间的关系。
本试验纳入了84例首次发生MCA中风的患者（41例左侧，43例右侧）。所有患者在中风发作后96小时内按照标准化方案进行了纤维内镜吞咽评估（FEES）。PSD根据6分纤维内镜吞咽困难严重程度量表进行分类。咽喉感觉通过基于FEES的触摸技术进行半定量评估。
PSD严重程度与咽喉感觉缺陷密切相关。关于感觉缺陷的侧化，中风侧对侧的感觉丧失略有但显著占优势。除此之外，发现右半球中风患者的PSD更严重。
本研究提供了证据，表明完整的感觉反馈对于正常吞咽至关重要，并突出了咽喉传入神经紊乱在PSD病理生理学中的关键作用。
