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      Correlation between brain injury and dysphagia in adult patients with stroke

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          Summary

          Introduction: In the literature, the incidence of oropharyngeal dysphagia in patients with cerebrovascular accident (AVE) ranges 20–90%. Some studies correlate the location of a stroke with dysphagia, while others do not.

          Objective: To correlate brain injury with dysphagia in patients with stroke in relation to the type and location of stroke.

          Method: A prospective study conducted at the Hospital de Clinicas with 30 stroke patients: 18 women and 12 men. All patients underwent clinical evaluation and swallowing nasolaryngofibroscopy (FEES ®), and were divided based on the location of the injury: cerebral cortex, cerebellar cortex, subcortical areas, and type: hemorrhagic or transient ischemic.

          Results: Of the 30 patients, 18 had ischemic stroke, 10 had hemorrhagic stroke, and 2 had transient stroke. Regarding the location, 10 lesions were in the cerebral cortex, 3 were in the cerebral and cerebellar cortices, 3 were in the cerebral cortex and subcortical areas, and 3 were in the cerebral and cerebellar cortices and subcortical areas. Cerebral cortex and subcortical area ischemic strokes predominated in the clinical evaluation of dysphagia. In FEES ®, decreased laryngeal sensitivity persisted following cerebral cortex and ischemic strokes. Waste in the pharyngeal recesses associated with epiglottic valleculae predominated in the piriform cortex in all lesion areas and in ischemic stroke. A patient with damage to the cerebral and cerebellar cortices from an ischemic stroke exhibited laryngeal penetration and tracheal aspiration of liquid and honey.

          Conclusion: Dysphagia was prevalent when a lesion was located in the cerebral cortex and was of the ischemic type.

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          Most cited references27

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          A penetration-aspiration scale.

          The development and use of an 8-point, equal-appearing interval scale to describe penetration and aspiration events are described. Scores are determined primarily by the depth to which material passes in the airway and by whether or not material entering the airway is expelled. Intra- and interjudge reliability have been established. Clinical and scientific uses of the scale are discussed.
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            Fiberoptic endoscopic examination of swallowing safety: a new procedure.

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              Supraglottic and pharyngeal sensory abnormalities in stroke patients with dysphagia.

              Dysphagia and aspiration are two devastating sequelae of stroke, accounting for nearly 40,000 deaths from aspiration pneumonia each year in the United States. While motor deficits in the larynx and pharynx are thought responsible for dysphagia and aspiration in stroke patients, no prior study has evaluated whether these patients also have sensory deficits. The aim of this study was to evaluate the sensory capacity of the laryngopharynx (LP) in supratentorial or brain stem stroke patients who presented with dysphagia. Fifteen stroke patients (mean age, 66.7 +/- 13.8 [SD] years) were prospectively evaluated by means of our previously described method whereby air pulse stimuli were delivered via a flexible fiberoptic telescope to the mucosa innervated by the superior laryngeal nerve. There were 15 age-matched controls. No LP sensory deficits were found in any of the age-matched controls. In all stroke patients studied, either unilateral (n = 9) or bilateral (n = 6) sensory deficits were identified. Deficits were defined as either a moderate impairment in sensory discrimination thresholds (3.5 to 6.0 mm Hg) or a severe sensory impairment (> 6.0 mm Hg). These sensory discrimination thresholds were significantly greater than in age-matched controls (7.05 +/- 0.17 mm Hg for the supratentorial group and 6.05 +/- 1.22 mm Hg for the infratentorial group versus 2.61 +/- 0.69 mm Hg for the controls). Among patients with unilateral deficits, sensory thresholds were moderately to severely elevated in all 9 cases on the affected side compared with the unaffected side (p < .01, Fisher's exact test). Moreover, the sensory thresholds of the unaffected side were not significantly different from those of age-matched controls (2.51 +/- 0.25 mm Hg versus 2.61 +/- 0.69 mm Hg, respectively). All 6 patients with bilateral deficits had severe impairments. The results of an outcome assessment in 13 of 15 patients revealed that 2 out of 5 patients with moderate LP sensory impairment and 5 out of 8 with severe impairment developed aspiration. Our results show for the first time that stroke patients with dysphagia have significant sensory deficits in the LP and that these impairments are likely to contribute to the development of aspiration.
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                Author and article information

                Journal
                Int Arch Otorhinolaryngol
                Int Arch Otorhinolaryngol
                10.1055/s-00025477
                International Archives of Otorhinolaryngology
                Thieme Publicações Ltda (Rio de Janeiro, Brazil )
                1809-9777
                1809-4864
                July 2012
                : 16
                : 3
                : 313-321
                Affiliations
                [1 ]Speech Therapist. Student Doctorate in Internal Medicine from the Universidade Federal do Paraná (HC-UFPR). Professor of the Specialization Course on Dysphagia and Voice of the University Tuiuti do Paraná – Curitiba/PR.
                [2 ]Geriatrician. Doctor of Sciences from the UNIFESP / EPM. Professor of Masters and Doctorate in Communication Disorders at the University Tuiuti - Curitiba/PR.
                [3 ]Speech Therapist. Student Doctorate in Internal Medicine from the Universidade Federal do Paraná (HC-UFPR). Professor of Masters and Doctorate in Communication Disorders at the University Tuiuti - Curitiba/PR.
                [4 ]Speech Therapist. Doctor in Human Communication Disorders from the Federal University of Sao Paulo. Professor of Speech Pathology, Federal University of Santa Catarina/SC.
                [5 ]Speech Therapist. Doctor in Linguistics from the Universidade Federal do Paraná (UFPR). Professor of Masters and Doctorate in Communication Disorders at the University Tuiuti - Curitiba/PR.
                [6 ]Speech Therapist. Student Master in Internal Medicine from the Universidade Federal do Paraná (HC-UFPR) - Curitiba/PR.
                [7 ]Neurologist. Doctor in Internal Medicine from the Universidade Federal do Paraná (HC-UFPR) - Curitiba/PR.
                Institution: Universidade Tuiutí do Paraná. Curitiba/PR - Brazil.
                Author notes
                Address for correspondence Maria Cristina de Alencar Nunes Travessa Capitão Clementino Paraná 130 - Apt. 171 - Bloco B - Bairro Água Verde - Curitiba/PR Brazil - Zip code: 80620-180 mcrisnunes@ 123456yahoo.com.br
                Article
                160303
                10.7162/S1809-97772012000300003
                4399643
                25991951
                009cfc37-cc57-43f4-b3da-11bce7f7fae6
                © Thieme Medical Publishers
                Categories
                Article

                stroke,deglutition disorders,ischemic attack,transient.
                stroke, deglutition disorders, ischemic attack, transient.

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