Objective In order to identify the factors that influence the swallowing function in patients who develop Wallenberg syndrome (WS) following lateral medullary infarction (LMI), we examined various patient characteristics, including the passage pattern abnormality (PPA) of a bolus through the upper esophageal sphincter (UES). Methods Fifty-four pure LMI patients with dysphagia participated in this study. PPA, defined as the failure of bolus passage through the UES corresponding to the intact side of the medulla, was identified during videofluorographic swallowing evaluations of each patient. On brain magnetic resonance imaging, the subjects' lesions were classified vertically into three levels and horizontally into seven levels in relation to the involvement of the ambiguous and/or solitary nuclei. Logistic regression analyses were performed for age, sex, PPA and the vertical and horizontal sites of the lesions. Results In terms of severity, 15 subjects were categorized as having mild dysphagia, 26 subjects were categorized as having moderate dysphagia and 13 were categorized as having severe dysphagia. Subjects with cephalic lesions, greater vertical spread of the lesion and PPA were more likely to have severe dysphagia. PPA and a greater vertical spread of the lesion were related to the severity of the functional outcome (p<0.01). The horizontal extent of the lesion was not strongly related to the prognosis. Conclusion The presence of PPA in LMI patients is suggestive of abnormalities in the swallowing pattern and, in turn, damage to the medullary central pattern generator. The presence of PPA and a greater vertical spread of the lesion can be useful predictors of severe dysphagia.

要旨 450 modified water swallow test: MWST 1 thickened liquid swallow test: TLST MWST TLST MWST 104 82 TLST 424 94.2 5 ADL recombinant tissue-type plasminogen activator MWST TLST

要旨： 【背景および目的】 頭蓋内内頸動脈塞栓性閉塞に対する二連吸引手技 (RAT) を用いた 緊急機械的血栓除去術 (EME) の有用性を明らかにする． 【方法】 当院入院の急性期虚血性脳血 管障害連続 1105 例中の EME 実施例を対象とし，背景因子，併用手技，成績を検討するとと もに，RAT 導入前後での成績を比較する． 【結果】 EME は 8 例で実施され全例 rtPA 静注禁 忌であった．RAT 導入後の 5 例中 3 例では併用手技なしに完全再開通を得たが，残りの 5 例 では血栓把持術と血管拡張術を併用した．大量血栓回収，backflow 出現，完全再開通は， RAT 導入前の 3 例では 1，0，0 例，RAT 導入後の 5 例では 5，5，4 例にみられた．重篤な 合併症や症候性頭蓋内出血はなく，RAT 導入後の完全再開通 4 例は予後良好 (modified Rankin scale ≦ 2) であった． 【結論】 頭蓋内内頸動脈塞栓性閉塞に対する RAT を用いた EME は有用である． Key words：emergency mechanical embolectomy, suction thrombectomy, emergency neuro-endovascular revascularization, running aspiration technique, ICA embolic occlusion (脳卒中 32：447-454，2010) 脳卒中 32 巻 5 号(2010：9) 32：448