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Isolated Dysphagia in a Patient with Medial Medullary Infarction − Effects of Evidence-Based Dysphagia Therapy: A Case Report

Samra hamzic.

a Department of Neurology, University Hospital Giessen and Marburg, Campus Giessen, Giessen, Germany

c Heart and Brain Research Group, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany

Patrick Schramm

b Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

Hassan Khilan

d Stroke Unit, Department of Neurology, Gesundheitszentrum Wetterau, Friedberg, Germany

Tibo Gerriets

Martin juenemann.

Medial medullary infarction (MMI) is a vascular occlusion in the medulla oblongata leading to certain constellations of neurological symptoms and seriously affecting the patient. Effective evidence-based treatment of severe dysphagia as sole symptom of MMI has not yet been reported. This case study aims to report successful effects of evidence-based therapy based on findings of dysphagia symptoms and pathophysiology of swallowing by flexible endoscopic evaluation of swallowing (FEES) in severe isolated dysphagia after MMI. FEES was performed to evaluate swallowing pathophysiology and dysphagia symptoms in a 57-year-old male with severe dysphagia after MMI. On the basis of FEES findings, simple and high-frequent evidence-based exercises for improvement of swallowing were implemented: thermal stimulation of faucial arches, Jaw Opening Exercise, and Jaw Opening Against Resistance. After 7 weeks of high-frequent evidence-based therapy and regular FEES evaluation the patient was set on full oral diet with no evidence of aspiration risk. In a first case report of isolated dysphagia in MMI our case illustrates that high-frequent evidence-based dysphagia therapy in combination with FEES as the method to evaluate and monitor swallowing pathophysiology can lead to successful and quick rehabilitation of severely affected dysphagic patients.

Introduction

Up to 80% of stroke survivors suffer dysphagia as a consequence of stroke [ 1 ]. Characteristic impairments of delayed swallowing reflex, decreased laryngeal elevation, and reduced motility of the upper esophageal sphincter (UES), leading to missequence of swallowing events, massive hypopharyngeal residue, and aspiration, are frequently seen in patients with brain stem stroke [ 2 , 3 ]. Dysphagia occurs in up to 78% of cases in medial medullary infarction (MMI) [ 4 ]. Delayed swallowing reflex is described as typical symptom of dysphagia in MMI [ 4 ] whereas decreased laryngeal elevation is mostly attributed to patients with lateral medullary infarction [ 4 ]. This case report describes a case of successful treatment of dysphagia as a sole symptom of stroke in medial medulla oblongata with delayed swallow reflex, impairment of laryngeal elevation, and reduced motility of UES as leading pathophysiology of swallowing as defined by flexible endoscopic evaluation of swallowing (FEES).

Case Report

We present a case of a 57-year-old German male scientist who was admitted to a municipal stroke unit (SU) in October 2016 with MMI and severe swallowing impairment as a sole neurological symptom.

The patient was first admitted to the department of Internal Medicine with symptoms of severe dysphagia and inability to elicit the swallowing reflex. Thoracic computed tomography and gastroscopy did not reveal any pathological findings. Due to suspected stroke the patient was then admitted to the SU. Modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) on admission to the SU were both zero (0). The neurological and general physical examination did not discover any neurological impairments. Further clinical findings included a struma multinodosa, insuline-dependent type II diabetes mellitus, hypothyreosis due to Hashimoto thyroiditis, vitiligo, and temporary Addison's disease. The patient had several allergies: hay fever, penicillin allergy, allergy to insect bites, and allergy to contrast agents for magnetic resonance tomography (MRI) and computed tomography.

Diffusion-weighted MRI and ADC map were able to visualize an elongated acute ischemia in the medial medulla oblongata on the left side. There were no indications of further strokes or a pronounced leukoencephalopathy. The brain-supplying arteries were examined using TOF-MRI and color-coded duplex sonography, showing a fetal supply of the middle cerebral artery on the right side, a high-grade stenosis of the basilar artery in the middle third, and an asymptomatic > 50% stenosis [ 5 ] of the middle cerebral artery on the right side. Further stroke workup included a Holter-ECG, transesophageal echocardiography (TEE), as well as examinations for thrombophilia and vasculitis. TEE revealed hypermobile interatrial septum and patent foramen ovale, but no other sources of cardiac embolism. Blood tests showed neither a predisposition to thrombophilia nor evidence of vasculitis.

On admission to the SU the patient was allocated to a more specific clinical swallowing examination (CSE) by a speech and language therapist (SLT). CSE from the day of admission on the SU showed an impairment of oropharyngeal sensitivity and a dysfunctional gag reflex. The palatal elevation was triggered with an extreme delay. During the CSE no spontaneous elicitation of swallowing reflex was recorded. There was no dysarthria, no facial palsy, no aphasia, no speech apraxia nor buccofacial apraxia. Clinical water swallow test was not conducted, since the swallow reflex was not elicitable. A second CSE 24 h later did not show any improvement in swallowing, not even after stimulation of palatal structures with ice. In order to evaluate the range of swallowing impairment and the risk of aspiration FEES was conducted 2 days after admission. The examination of hypopharyngeal and laryngeal structures at rest and in motion showed no impairment. No food or fluids were administered since no swallowing reflex was elicited. The main symptoms found in the initial FEES were severe saliva residue in piriform sinus and valleculae and the inability to initiate swallowing reflex (Fig. ​ (Fig.1a). 1a ). There were no hints on saliva aspiration since the patient was regularly expectorating saliva residue.

An external file that holds a picture, illustration, etc.
Object name is crn-0013-0190-g01.jpg

Symptoms of dysphagia in the course of treatment as seen in flexible endoscopic evaluation of swallowing (FEES). Figure demonstrates the photo documentation of FEES examinations in the course of the treatment with Penetration-Aspiration-Scale (PAS) and Yale Pharyngeal Residue Severity Rating Scale for valleculae (YSv) and piriform sinus (YSps) scores: a shows the massive saliva residue in valleculae and piriform sinus in the initial FEES (YSv 5/YSps 5); in b penetration of liquid on the right side (PAS 3) and mild residue of liquid bolus (YSps 3) is perceived in piriform sinus 3 days after admission; c depicts penetration (PAS 3) and massive residue of puree in valleculae and piriform sinus (YSv 5/YSps 5) 2 weeks after stroke; d (24 days post onset) shows massive residue of solid bolus in valleculae and only moderate residue in piriform sinus (YSv 5/YSps 4); in d no pathological results were documented.

Initial secondary prevention with acetylsalicylic acid was substituted by oral anticoagulation with Edoxaban 60 mg/day following the findings of TEE. Furthermore, high-dose simvastatin was added. In principle, with a high-grade stenosis of the A. basilaris and under the condition of supply variants of the brain stem, a macroangiopathic etiology of cerebral infarction is possible. Nevertheless, initial secondary prevention with acetylsalicylic acid was substituted by oral anticoagulation with Edoxaban 60 mg/day following the findings of TEE. Furthermore, high-dose simvastatin was added.

Since the admission on the SU the patient was nourished via nasogastric tube. Due to dysphagia as sole symptom of stroke the discharge was planned for day 7 after admission and continuation of dysphagia therapy in an outpatient setting was recommended. Nourishment was to be proceeded via nasogastric tube. Since the patient planned on resuming his professional activity immediately after discharge PEG was placed 5 days after admission upon patient's request.

The underlying symptoms of dysphagia found in FEES (non-elicitable swallowing reflex, severe residue of saliva in valleculae and piriform sinus, Fig. ​ Fig.1a) 1a ) gave hint of swallowing pathophysiology. The swallowing reflex in normal subjects is elicited at the end of the volitional phase of swallowing when bolus contacts the anterior faucal arches (AFA) allowing the glossopharyngeal nerve to elicit swallowing reflex by transmitting afferent signals to the reticular formation (RF) and nucleus tractus solitarii (NTS) in the dorsolateral medulla oblongata. The inability to trigger the swallowing reflex in MMI may be caused by the stroke-related damage caused to RF and NTS (Fig. ​ (Fig.2) 2 ) [ 2 , 6 ]. Studies conducted on different patient groups with neurogenic dysphagia showed that thermal stimulation of AFA with ice can lead to quicker triggering of swallowing reflex [ 6 ]. In our case study stimulation of oropharyngeal structures with ice was conducted 3×/day by rubbing the AFA five times on each side with an ice stick [ 6 ]. Swallowing reflex was elicited for the first time after 3 days of ice stimulation.

An external file that holds a picture, illustration, etc.
Object name is crn-0013-0190-g02.jpg

MRI scan. a Diffusion-weighted imaging. b T2-weighted MRI. Green circle represents reticular formation. Blue circle represents nucleus ambiguus.

The symptoms of residue in piriform sinus and valleculae may point out to impairments in hyoid bone elevation, laryngeal elevation, and tongue base retraction as well as impaired opening of the UES due to impaired hyoid bone elevation and laryngeal elevation [ 2 ]. We introduced exercises which are proven to amend these mechanisms: Chin tuck against resistance (CTAR) [ 7 ] and jaw opening exercise (JOE) [ 8 ]. These exercises have a positive influence on strengthening suprahyoidal muscles and can improve hyoid bone and laryngeal elevation and opening width of UES, thus reducing residue in piriform sinus and valleculae [ 7 , 8 ].

We conducted the following high-frequent treatment (Fig. ​ (Fig.3): 3 ): (1) 3×/day ice stimulation of anterior faucial arches five times on each side with an ice stick; (2) each five sets of five repetitions of CTAR and JOE for 10 s with 10 s break between each repetition. At the time of discharge from hospital (7 days after admission on the SU), we recommended to continue with the abovementioned treatment frequency at home plus an extra SLT therapy treatment five times a week for 7 weeks. Only oral intake of small liquid boli was recommended at the time of discharge from hospital.

An external file that holds a picture, illustration, etc.
Object name is crn-0013-0190-g03.jpg

Timeline. Figure shows the milestones of symptoms, diagnostics and therapy. FEES, flexible endoscopic evaluation of swallowing; FOIS, Functional Oral Intake Scale; JOAR, Jaw Opening Against Resistance; JOE, Jaw Opening Exercise; MRI, magnetic resonance imaging; mRS, Modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; PEG, percutaneous endoscopic gastrostomy; SU, stroke unit.

Outcome measure for swallow security as diagnosed via FEES were Penetration-Aspiration-Scale (PAS) [ 9 ], Yale Pharyngeal Residue Severity Rating Scale for valleculae (YSv) and for piriform sinus (YSps) [ 10 ], and the Functional Oral Intake Scale [ 11 , 12 ].

The patient conducted the recommended swallow exercises at home and five times a week in the outpatient clinic of the SU with the same SLT who conducted all FEES examinations. To control the effects of the therapy the SLT conducted five FEES examinations within the 7 weeks of therapy, two FEES during the hospital stay, and three follow-up FEES after discharge (Fig. ​ (Fig.1, 1 , ​ ,3, 3 , ​ ,4). 4 ). At discharge the ice stimulation was not needed anymore, since the swallowing reflex was elicited regularly as confirmed via FEES. Nevertheless, pharyngeal residue scores for saliva were continuously severe (YSv 5/YSp 5) at discharge. However, the patient was able to swallow small liquid boli without aspiration (PAS 2) despite high residue score (YSp 4). Only oral intake of small liquid boli was allowed at discharge, since overall residue and penetration-aspiration scores for puree were severe (YSv 5/YSp 5/PAS 5). Six weeks after discharge all dysphagia scores showed no relevant aspiration risk (Fig. ​ (Fig.4). 4 ). The rapid therapy success allowed for full oral diet and a quick PEG removal a few weeks later.

An external file that holds a picture, illustration, etc.
Object name is crn-0013-0190-g04.jpg

Dysphagia severity scores as measured by flexible endoscopic evaluation of swallowing (FEES) in the course of 7 weeks of dysphagia therapy with Jaw Opening Exercise (JOE) and Jaw Opening Against Resistance (JOAR). The figure shows the measured dysphagia scores in the consecutive FEES in the course of treatment. Increasing Penetration-Aspiration-Scale (PAS; left upper graph) and Yale Pharyngeal Residue Severity Rating Scale for valleculae (YSv; right upper graph) and piriform sinus (YSps; left lower graph) scores indicate increased dysphagia severity. Increasing Functional Oral Intake Scale (FOIS; right lower graph) scores indicate an improvement in total oral intake.

According to previous studies, 78% of patients suffer dysphagia after MMI [ 4 ]. In our case study the patient showed symptoms both of an impairment in the timing of swallowing reflex as well as in the range of laryngeal elevation, thus contributing to an insufficient opening of the UES. Whereas direct involvement of the nucleus ambiguus (NA) may be the cause of impairment in the range of laryngeal elevation in lateral medullary infarction, it is suggested that in MMI the impairment in the timing of swallowing reflex may be due to the destruction of the corticobulbar fibers which are innervating the NA. However, damage to other swallow-relevant brainstem structures may also explain the impairment in the timing of swallowing reflex: central pattern generators (CPGs) are situated in RF which encompasses the NA. Impairment in the timing of swallowing reflex could be explained by potential damage to CPGs in MMI [ 4 ].

New methods of dysphagia therapy (transcranial direct current stimulation, repetitive transcranial magnetic stimulation, pharyngeal electrical stimulation) are all very effective in the treatment of neurogenic dysphagia on the one side, but not always applicable to every patient. This case study shows that standard, but high-intensity evidence-based dysphagia treatment based on FEES-proven pathophysiology can improve the swallowing of patients with severe dysphagia after MMI within a rather short period of time. In recent years FEES diagnostics has gained more importance in the diagnostics of dysphagic stroke patients. Various studies have confirmed that near-time implementation of FEES after stroke as primary instrument for diagnostics of dysphagia can predict severe dysphagia 3 months post-onset and contributes to better outcome, lower rates of mechanical ventilation and pneumonia, as well as shorter length of hospital stay [ 13 , 14 , 15 , 16 ]. Works of Braun et al. on the usefulness of FEES in neurologic, stroke, and intensive care patients have shown that FEES diagnostics is crucial and has an important influence on overall outcome solely on the basis of dietary adjustment after FEES. In an investigation of 241 patients with various neurological diseases only 33.1% had an adequate oral diet prior to FEES [ 14 ]. In this study significant lower rates of mortality and aspiration pneumonia were recorded after the change of oral diet based on FEES findings. In only 31% of investigated dysphagic cases on a stroke unit (SU) did the clinical assessment identify a proper oral diet [ 15 ]. In this study the change of oral diet based on FEES findings correlated with a better overall outcome at discharge from SU, shorter length of stay, lower rate of aspiration pneumonia, and lower need for mechanical ventilation. Similar results are found in the work of Braun et al. on the usefulness of FEES in the neurological intensive care unit (ICU) [ 16 ]. FEES detected dysphagia in 72% of investigated cases and allowed for adjustment of oral diet in 64% of investigated cases after FEES contributing to lower mortality and morbidity. Therefore, our case study emphasizes all the more the relevance of frequent use of FEES during dysphagia treatment in acute and post-acute phase of stroke to determine not only an adequate oral diet but also effective therapy methods and prove its efficacy based on genuine description of pathophysiology as seen in FEES.

This case report describes a case of successful treatment of dysphagia as a sole symptom of stroke in medial medulla with impairments in the timing of swallowing reflex and the range of laryngeal elevation. Simple high-frequent and evidence-based methods of dysphagia therapy combined with FEES as diagnostic and biofeedback method of evaluation of therapy efficiency were applied ending in total oral diet and removal of PEG tube after a short period of time.

Statement of Ethics

This study was approved by the ethics committee of the University of Giessen (Az. 208/16). This case study has been carried out in accordance with The World Medical Association's Declaration of Helsinki for experiments involving humans. Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Conflict of Interest Statement

S. Hamzic, P. Schramm, H. Khilan, T. Gerriets declared that they have no conflict of interest. M. Juenemann has received grants from German Heart Research Foundation (Deutsche Stiftung für Herzforschung) and from Kerckhoff-Foundation (Kerckhoff-Stiftung) with no relevance to the paper.

Funding Sources

No funding has been received for this case report.

Author Contributions

S.H. designed the case study, performed all examinations and therapies. T.G. supervised the project. S.H. wrote the manuscript. S.H. and H.K. provided data for all figures. P.S. and M.J. contributed to the final version of the manuscript. All authors discussed the results and reviewed the final manuscript.

Case Report Guidelines (CARE) Compliance

This case report was written according to the Case Report Guidelines (CARE): https://www.care-statement.org .

Acknowledgement

We would like to thank our patient who gave his written informed consent for this case report.

Swallowing Abnormalities after Acute Stroke: A Case Control Study

  • Published: August 1999
  • Volume 14 , pages 212–218, ( 1999 )

Cite this article

  • Cameron Sellars 1 ,
  • Angela M. Campbell 2 ,
  • David J. Stott 2 ,
  • Murray Stewart 3 &
  • Janet A. Wilson 4  

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Dysphagia is a common and potentially fatal complication of acute stroke. However, the underlying pathophysiology, especially the relative importance of motor and sensory dysfunction, remains controversial. We conducted a case control study of 23 acute stroke patients (mean age = 72 yr) at a median of 6 days poststroke and 15 healthy controls (mean age = 76 yr). We used novel methods to assess swallowing in detail, including a timed videoendoscopic swallow study and oral sensory threshold testing using electrical stimulation. Vocal cord mobility and voluntary pharyngeal motor activity were impaired in the stroke group compared with the controls ( p = 0.01 and 0.03). There was a delay during swallowing in the time to onset of epliglottic tilt in the stroke group, particularly for semisolids ( p = 0.02) and solids ( p = 0.01), consistent with a delay in initiation of the swallow. Sensory thresholds were not increased in the stroke group compared with controls. We conclude that pharyngeal motor dysfunction and a delay in swallow initiation are common after acute stroke. Vocal cord mobility is reduced, and this may result in reduced airway protection. We found no evidence to support the hypothesis that oropharyngeal sensory dysfunction is common after acute stroke.

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Department of Speech and Language Therapy, Glasgow Royal Infirmary, Glasgow, UK, , , , , , GB

Cameron Sellars

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Department of Otolaryngology, Glasgow Royal Infirmary, Glasgow, UK, , , , , , GB

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Janet A. Wilson

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Sellars, C., Campbell, A., Stott, D. et al. Swallowing Abnormalities after Acute Stroke: A Case Control Study. Dysphagia 14 , 212–218 (1999). https://doi.org/10.1007/PL00009608

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  • Key words: Stroke — Dysphagia — Nasendoscopy — Oral sensory thresholds — Deglutition — Deglutition disorders.
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Transient Left-Sided Weakness, Facial Palsy in Middle-Age Man

— timely recognition of this rare phenomenon considered crucial to prevent recurrent stroke.

by Kate Kneisel , Contributing Writer, MedPage Today February 20, 2024

A photo of a man rubbing the left side of his face.

Why did a 51-year-old man with no significant medical history suddenly develop slurred speech and left-sided symptoms -- weakness in his arm, a drooping eyebrow and mouth -- that seemed to resolve 15 minutes later?

That's the diagnostic challenge described by Unal Mutlu, MD, PhD, of Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues.

On neurological examination, clinicians detailed that the left nasolabial fold was completely absent, but found no other focal deficits. The patient's blood pressure, electrocardiograph, and cardiac monitoring results were normal.

The patient underwent a CT scan that revealed "hypodense areas in the vascular territory of the right medial cerebral artery, indicating cerebral infarctions. These findings were confirmed by subsequent magnetic resonance imaging denoting diffusion restriction to the corresponding areas with a high T2 signal, swelling, and subtle cortical enhancement," according to the case report in JAMA Neurology .

Clinicians ordered a CT angiography, which revealed a small irregularity on the posterior margin of the right carotid bulb, which raised suspicions that the patient's symptoms were due to a carotid web.

"In our neurovascular multidisciplinary team, the possibility of either a thrombus or a soft plaque was suggested as an alternative diagnosis to a potential CW [carotid web]," wrote Mutlu and co-authors. They performed a second CT angiography, and were surprised to see that the focal irregularity had moved forward to the anterior wall of the right carotid bulb.

Importantly, the orientation of the two arteries had changed, they observed, such that "the internal carotid artery was oriented medially to the external carotid artery, as opposed to posteriorly in the previous scan and more retropharyngeal."

Taken together, the medial movement of the carotid artery reflected the possibility that it was wandering and rotating on its own axis, they said, noting that it had twisted approximately 120°. The contralateral carotid arteries were in a fixed position.

The presence of carotid web was confirmed subsequently, when clinicians performed a successful carotid endarterectomy, thus excluding the potential etiologies of soft plaque and thrombus.

"To our knowledge, we present the first case of a wandering carotid artery combined with a CW," wrote Mutlu and co-authors. A carotid web represents a specific form of fibromuscular dysplasia, notable for its presentation of a shelflike projection usually located on the inner lining of the carotid bulb. It presents as a thin layer of proliferative intima, originating exclusively from the posterior wall, they explained.

Among patients affected by symptomatic carotid web, up to 17% of patients will have repeated strokes within 2 years despite receiving medical management, "suggesting that medication alone may not provide sufficient protection," according to the case authors.

This makes timely recognition of a carotid web crucial to provision of optimal stroke prevention. In this specific case, "the CW appeared to be on the anterior side and could have been missed or misinterpreted as a potential cause of stroke due to the changing position and rotation of the carotid artery," the authors detailed.

"The underlying mechanism of this rare anomaly in which the carotid artery changes its position remains unknown," they continued. "Awareness of this phenomenon is important for neck surgical procedures to avoid perioperative and postoperative complications. At which degree this movement and twisting predisposes an individual to stroke remains to be elucidated."

In patients with no other causes of stroke, the presence of a focal irregularity of the carotid bulb, even on the anterior side, should be investigated for a potential carotid web, in case of a wandering carotid.

"Knowledge of this phenomenon may aid radiologists and other clinicians in properly recognizing this serious condition to optimize secondary prevention of ischemic stroke in these patients," the case report authors concluded.

author['full_name']

Kate Kneisel is a freelance medical journalist based in Belleville, Ontario.

Disclosures

Mutlu and co-authors reported no conflicts of interest.

Primary Source

JAMA Neurology

Source Reference: Mutlu U, et al "Shifting carotid web due to a wandering and rotating carotid artery" JAMA Neurol 2024; DOI: 10.1001/jamaneurol.2023.5641.

Risk of cardiovascular events after influenza: A population-based Self Controlled Case Series study, Spain 2011-2018

Affiliations.

  • 1 Vaccines Research Unit. Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Valencia, Spain.
  • 2 CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
  • 3 Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.
  • PMID: 38330324
  • DOI: 10.1093/infdis/jiae070

This study explores the relationship between influenza infection, both clinically diagnosed in primary-care and laboratory confirmed in hospital, and atherothrombotic events (acute myocardial infarction and ischemic stroke) in Spain. A population-based self-controlled case series design was used with individual-level data from electronic registries (n = 2,230,015). The risk of atherothrombotic events in subjects ≥50 years old increased more than 2-fold during the 14 days after the mildest influenza cases in patients with fewer risk factors and more than 4-fold after severe cases in the most vulnerable patients, remaining in them more than 2-fold for 2 months. The transient increase of the association, its gradient after influenza infection and the demonstration by 4 different sensitivity analyses provide further evidence supporting causality. This work reinforces the official recommendations for influenza prevention in at-risk groups and should also increase the awareness of even milder influenza infection and its possible complications in the general population.

Keywords: Influenza; atherothrombotic; cardiovascular; clinically diagnosed influenza; electronic healthcare registries; ischemic stroke; laboratory confirmed influenza; myocardial infarction; population-based; self-controlled case-series.

© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

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  1. Isolated Dysphagia in a Patient with Medial Medullary Infarction − Effects of Evidence-Based Dysphagia Therapy: A Case Report

    This case report describes a case of successful treatment of dysphagia as a sole symptom of stroke in medial medulla oblongata with delayed swallow reflex, impairment of laryngeal elevation, and reduced motility of UES as leading pathophysiology of swallowing as defined by flexible endoscopic evaluation of swallowing (FEES). Go to: Case Report

  2. Management of Dysphagia Following Stroke: A Case Study

    Supraglottic and pharyn-geal sensory abnormalities in stroke patients with dysphagia. Annals of Otology, Rhinology, and Laryngology, 105, 92-97. Google Scholar. Barer, D. H. ... The practice of evidence-based practice: A case study approach. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 16, 4-8.

  3. Swallowing Therapy for Dysphagia in Acute and Subacute Stroke

    Dysphagia is common after stroke and associated with a poor outcome. Swallowing therapies for dysphagia are aimed at accelerating recovery of swallowing. This is an update of a 2012 Cochrane review and assesses the effects of swallowing therapy on poststroke dysphagia within 6 months of onset.

  4. The assessment of dysphagia after stroke: state of the art and future

    Prof Sonja Suntrup-Krueger, MD Paul Muhle, MD et al. Show all authors Published: September, 2023 DOI: https://doi.org/10.1016/S1474-4422 (23)00153-9 The assessment of dysphagia after stroke: state of the art and future directions Summary Dysphagia is a major complication following an acute stroke that affects the majority of patients.

  5. The Benefit of Dysphagia Screening in Adult Patients With Stroke: A

    Dysphagia is common following stroke, affecting ≈55% of acute stroke patients, 1 and leads to complications such as aspiration pneumonia, 1 malnutrition, 2 dependency, and mortality. 1, 3 There has been recent effort to promote early identification of dysphagia with screening as a critical first step to promote improved recovery. Best practice stroke guidelines 4, 5 state level 2 evidence to ...

  6. Association of Lesion Pattern and Dysphagia in Acute Intracerebral

    Introduction. Dysphagia is a common symptom of acute stroke. It is associated with pneumonia, malnutrition, dehydration, increased mortality, and poor long-term outcome. 1-3 It has been shown that early detection of dysphagia allows for immediate intervention and thereby reduces morbidity, duration of hospitalization, and overall health care costs. 4,5 In this context, several studies have ...

  7. Dysphagia-related acute stroke complications: A retrospective

    Dysphagia, or impaired swallowing, is reported to affect between 8.1% and 45.3% of patients following stroke.1 Dysphagia is associated with longer length of stay (LOS) in acute hospital, increased healthcare costs, and greater long-term institutionalisation.2,3 Aspiration pneumonia mediates a significant proportion of this deleterious association and, in its own right, is associated with ...

  8. Best Practice Recommendations for Stroke Patients with Dysphagia: A

    Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome following acute stroke and it continues to be effective for many years. This consensus-based guideline is not only a good address to clinical questions in practice for the clinical management of dysphagia including management, diagnosis, follow-up, and rehabilitation methods ...

  9. Management of Dysphagia Following Stroke: A Case Study

    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 ...

  10. Dosages of swallowing exercises in stroke rehabilitation: a ...

    Purpose To investigate the dosages of swallowing exercises reported in intervention studies on post-stroke dysphagia through systematic review. Methods Five electronic databases were searched from inception until February 2022 with reference tracing of included studies. Studies were included, where adults with post-stroke dysphagia received rehabilitative, behavioural swallowing exercises, pre ...

  11. Factors influencing speech pathology practice in dysphagia after stroke

    In brief, dysphagia is a common problem after a stroke that negatively impacts on physical and psychosocial health. Dysphagia rehabilitation aims to improve swallowing and mitigate negative impacts (Speyer et al., 2022). Dysphagia management involves timely and accurate assessment and compensatory and rehabilitative intervention (Dziewas et al ...

  12. Swallowing Abnormalities after Acute Stroke: A Case Control Study

    Dysphagia is a common and potentially fatal complication of acute stroke. However, the underlying pathophysiology, especially the relative importance of motor and sensory dysfunction, remains controversial. We conducted a case control study of 23 acute stroke patients (mean age = 72 yr) at a median of 6 days poststroke and 15 healthy controls (mean age = 76 yr). We used novel methods to assess ...

  13. Risk factors and Outcomes of Dysphagia Among Patients ...

    Objective: Dysphagia is a common and severe symptom of acute stroke; however, few studies investigated the prevalence of and risk factors of dysphagia among intracerebral hemorrhage (ICH) patients. We aimed to determine the prevalence and risk factors for dysphagia among acute ICH patients, and assess its impact on outcome of hospitalization.

  14. 73-Year-Old Man With Recent-Onset Dysphagia

    1. In this patient, which one of the following features is most helpful in determining the location of his dysphagia? a. Dysphagia to solids b. Progressively worsening clinical course c. History of GERD d. Lack of weight loss e. Difficulty initiating swallows The medical history is key in the evaluation of dysphagia.

  15. Inpatient Dysphagia: A Case Study

    A.M., a 54-year-old male status post stroke with right-side paresis, was admitted to Kessler Institute for Rehabilitation in West Orange, N.J., on August 31, 2015 following a 13-day stay in an acute care hospital. The patient's medical history included obesity, hypertension and hypercholesterolemia.

  16. Dysphagia Screening: State of the Art

    Janice Weinhardt presented a case study example of how one interdisciplinary stroke unit translated the current science into practice using a CQI approach to dysphagia screening. The project began because of a high level of patient, physician, and nurse dissatisfaction about stroke patients being kept NPO until an SLP could conduct a formal ...

  17. Stroke and dysphagia

    First published: 05 March 2016 https://doi.org/10.1002/9781119163411.ch36 PDF Tools Share Summary This chapter discusses the case of a 74-year-old married woman, Anne, who went to her GP following a dizzy spell, but no problems were diagnosed.

  18. Transient Left-Sided Weakness, Facial Palsy in Middle-Age Man

    Case Studies > Neurology Transient Left-Sided Weakness, Facial Palsy in Middle-Age Man — Timely recognition of this rare phenomenon considered crucial to prevent recurrent stroke

  19. Neuron-specific enolase at admission as a predictor for stroke volume

    An ideal blood biomarker for stroke should provide reliable results, enable fast diagnosis, and be readily accessible for practical use. Neuron-specific enolase (NSE), an enzyme released after neuronal damage, has been studied as a marker for brain injury, including cerebral infarction. However, different methodologies and limited sample sizes have restricted the applicability of any potential ...

  20. Risk of cardiovascular events after influenza: A population ...

    This study explores the relationship between influenza infection, both clinically diagnosed in primary-care and laboratory confirmed in hospital, and atherothrombotic events (acute myocardial infarction and ischemic stroke) in Spain. A population-based self-controlled case series design was used wit …