Correlation between brain injury and dysphagia in adult patients with stroke

Nunes, Maria Cristina de Alencar; Jurkiewicz, Ari Leon; Santos, Rosane Sampaio; Furkim, Ana Maria; Massi, Giselle; Pinto, Gisele Sant ́Ana; Lange, Marcos Christiano

doi:10.7162/s1809-97772012000300003

Cited by 18 publications

(2 citation statements)

References 14 publications

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“…To monitor OD, it is absolutely required to proceed to the clinical evaluation of the swallowing associated with a videofluoroscopic or nasofibrolaryngoscopic instrumental assessment of swallowing. 13…”

Section: Discussionmentioning

confidence: 99%

Swallowing in Patients with Mental Disability - Analysis of 189 Swallowing Video Endoscopies

Pirana

Oliveira²,

Pissini³

et al. 2018

Int Arch Otorhinolaryngol

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Introduction Feeding, swallowing and breathing are fundamental activities for the survival and well-being of humans; these functions are performed by the most complex neuromuscular unit of the human body, which, when altered, may raise morbidity and mortality rates. Objective To evaluate deglutition in patients with mental disability in order to determine the incidence and the severity of dysphagia. Methods A total of 189 institutionalized adult patients with mental disability were analyzed using a 3.2 mm flexible fiberscope (Machida, Japan 1995). The following food consistencies were tested: pasty, thickened liquid and liquid. Results Among the total of 189 patients, 101 (53.4%) were female aged between 14 and 55 years old. Most of them 120 (63.5%) had profound mental deficiency, 58 (30.7%) had severe mental deficiency, 9 (4.8%) had moderate mental deficiency, and 2 (1.1%) had mild mental deficiency. Gender and the degree of mental deficiency did not influence significantly the degree of dysphagia. Age, degree of disability and interaction between age groups and degrees of disability influenced significantly the degree of dysphagia. Younger patients are more likely to present more severe dysphagia. Stabilization occurs between 31 and 40 years of age, and above this age, a greater chance of less severe dysphagia, because the increase in the degree of mental deficiency decreases the probability of more severe dysphagia. Conclusion The population that mostly presented severe dysphagia was characterized by being mostly female, with profound mental deficiency, with an average age of 36.7 years. There was no relationship between gender and the degree of mental disability concerning the degree of dysphagia.

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Section: Discussionmentioning

confidence: 99%

Swallowing in Patients with Mental Disability - Analysis of 189 Swallowing Video Endoscopies

Pirana

Oliveira²,

Pissini³

et al. 2018

Int Arch Otorhinolaryngol

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“…Stroke causes neurogenic dysphagia that besides limiting food intake, it carries a greater risk of malnutrition and tracheal aspiration and triples the incidence of aspiration pneumonia (Baroni et al 2012 ). This higher risk is due to the possibility of silent aspiration (without cough reflex), micro aspiration, impairment of the laryngeal closure mechanism, delayed swallow initiation, motor dysfunction of the pharynx, presence of pharyngeal residues at epiglottic valleculae, pyriform sinuses, and posterior wall of the pharynx (Nunes et al 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Mean platelet volume to platelet count ratio as a laboratory indicator of mortality in pneumonia following ischemic stroke

Nageeb

AboZaid

Nageeb

et al. 2018

Egypt J Neurol Psychiatry Neurosurg

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BackgroundPlatelets have a vital role in antimicrobial host defenses. The objective of this study was to evaluate if increased mean platelet volume to platelet count (MPV/PC) ratio in acute ischemic stroke patients complicated with pneumonia was associated with increased mortality risk.MethodsThe current study was conducted at Zagazig University Hospitals. It included 500 acute ischemic stroke patients classified as group 1 that included 51 patients complicated with pneumonia after admission and group 2 that included the remaining 449 patients. Clinical assessment was carried out to exclude comorbid medical illnesses likely to interfere with platelet function or morphology. Laboratory investigations including MPV/PC ratio and brain imaging were carried out for all patients.ResultsThere was a significant difference between both groups regarding age, National Institutes of Health Stroke Scale (NIHSS) score, and mortality within 30 days (p = 0.02, 0.03, 0.01). There was a significant difference between survivors and non-survivors of group 1 regarding to pneumonia severity index (PSI) classes IV and V (p = 0.01 and 0.02, respectively). Also, there was a significant difference regarding confusion, urea ≥ 7 mmol/L, respiratory rater ≥ 30 breaths/min, systolic blood pressure ≤ 90 mmHg or diastolic blood pressure ≤ 60 mmHg, and age ≥ 65 years at pneumonia occurrence (CURB-65) scores 3, 4, and 5 (p = 0.03, 0.02, and 0.01, respectively). Moreover, there was a significant difference regarding decreased GCS score at pneumonia occurrence, higher NIHSS scores, PSI, and higher MPV/PC ratio (p = 0.01, 0.01, 0.028, and 0.01, respectively). Age > 65 years, need for mechanical ventilation, GCS score of > 9, PSI class ≥ IV, CURB-65 scores ≥ 3, and increased MPV/PC ratio were all significantly associated with 30-day mortality in group 1 (p = 0.03, 0.01, 0.001, 0.04, 0.01, and 0.03, respectively). The predictors of 30-day mortality risk factors were GCS less than 9, increased MPV/PC ratio, and CURB-65 scores ≥ 3 (p = 0.001, 0.05, and 0.01, respectively).ConclusionsOnce pneumonia develops, MPV/PC ratio could be considered a significant laboratory indicator of 30-day mortality.

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Localization of orofacial representation in the corona radiata, internal capsule and cerebral peduncle inMacaca mulatta

Morecraft

Binneboese

Stilwell-Morecraft

et al. 2017

J of Comparative Neurology

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Subcortical white matter injury is often accompanied by orofacial motor dysfunction, but little is known about the structural substrates accounting for these common neurological deficits. We studied the trajectory of the corticobulbar projection from the orofacial region of the primary (M1), ventrolateral (LPMCv), supplementary (M2), rostral cingulate (M3) and caudal cingulate (M4) motor regions through the corona radiata (CR), internal capsule (IC) and crus cerebri of the cerebral peduncle (ccCP). In the CR each pathway was segregated. Medial motor area fibers (M2/M3/M4) arched over the caudate and lateral motor area fibers (M1/LPMCv) curved over the putamen. At superior IC levels, the pathways were widespread, involving the anterior limb, genu and posterior limb with the M3 projection located anteriorly, followed posteriorly by projections from M2, LPMCv, M4 and M1, respectively. Inferiorly, all pathways maintained this orientation but shifted posteriorly, with adjacent fiber bundles overlapping minimally. In the ccCP, M3 fibers were located medially and M1 fibers centromedially, with M2, LPMCv, and M4 pathways overlapping in between. Finally, at inferior ccCP levels, all pathways overlapped. Following CR and superior IC lesions, the dispersed pathway distribution may correlate with acute orofacial dysfunction with spared pathways contributing to orofacial motor recovery. In contrast, the gradually commixed nature of pathway representation inferiorly may enhance fiber vulnerability and correlate with severe, prolonged deficits following lower subcortical and midbrain injury. Additionally, in humans these findings may assist in interpreting orofacial movements evoked during deep brain stimulation, and neuroimaging tractography efforts to localize descending orofacial motor pathways.

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Correlation between brain injury and dysphagia in adult patients with stroke

Cited by 18 publications

References 14 publications

Swallowing in Patients with Mental Disability - Analysis of 189 Swallowing Video Endoscopies

Swallowing in Patients with Mental Disability - Analysis of 189 Swallowing Video Endoscopies

Mean platelet volume to platelet count ratio as a laboratory indicator of mortality in pneumonia following ischemic stroke

Localization of orofacial representation in the corona radiata, internal capsule and cerebral peduncle inMacaca mulatta

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