Background: Patients with severe dysphagia after stroke are usually fed using a nasogastric tube. However, this method is inconvenient and causes complications. The oro-esophageal (OE) tube has been used as an alternative parenteral feeding method for patients for whom safe oral feeding is impossible. This study aimed to evaluate the therapeutic effects and complications of OE tube feeding in stroke patients with dysphagia. Methods: This study was designed as a retrospective medical chart review of dysphagic stroke patients who were recommended for OE tube feeding. Thirty-eight stroke patients were recommended for OE tube feeding according to videofluoroscopic swallowing study (VFSS) findings. Of those patients, 17 received OE tube feeding training and conventional dysphagia therapy. Follow-up VFSSs were performed sequentially based on the patients’ conditions. When a patient was able to swallow therapeutic foods with specific viscosities during the VFSS, oral feeding was considered to be initiated. Patients were divided into two groups according to final feeding methods. Results: Seventeen patients attempted OE tube feeding. Among them, 64.7% of the patients could change to full oral feeding at their follow-up VFSS evaluation. Additionally, 70.6% of the patients showed gastroesophageal reflux disease regardless of whether they changed to oral feeding. On individual items of the Functional Dysphagia Scale, both groups showed significant improvements in the triggering of pharyngeal swallowing, the amount of residue, and the pharyngeal transit time. These functions were better improved in the patients who could change to oral feeding than in those who could not. Both groups showed significant aggravation of nasal penetration. Conclusion: Our study quantitatively shows the therapeutic effects and complications of OE tube training. OE tube feeding can facilitate the swallowing process and assist patients in transitioning to oral feeding. This easy-to-apply technique may significantly impact future treatment strategies in stroke patients with severe dysphagia.
In the elderly, myasthenia gravis (MG) can present with bulbar symptoms, which can be clinically difficult to diagnose from other neurological comorbid conditions. We describe a case of a 75-year-old man who had been previously diagnosed with dysphagia associated with medullary infarction but exhibited aggravation of the dysphagia later on due to a superimposed development of bulbar MG. After recovering from his initial swallowing difficulties, the patient suddenly developed ptosis, drooling, and generalized weakness with aggravated dysphagia. Two follow-up brain magnetic resonance imaging (MRI) scans displayed no new brain lesions. Antibodies to acetylcholine receptor and muscle-specific kinase were negative. Subsequent electrodiagnosis with repetitive nerve stimulation tests revealed unremarkable findings. A diagnosis of bulbar MG could only be established after fiberoptic endoscopic evaluation of swallowing (FEES) with simultaneous Tensilon application. After application of intravenous pyridostigmine, significant improvement in dysphagia and ptosis were observed both clinically and according to the FEES.
Cavus foot is a deformity marked by an abnormally high medial longitudinal arch, rendering the foot inflexible in severe cases. Inherent defects include pro-nated forefoot, first metatarsal valgus, and hindfoot varus. Hindfoot varus and forefoot valgus produce foot pain and lateral ankle instability. Long-term complications of cavus foot are metatarsalgia, fifth metatarsal stress fracture, plantar fasciitis, and iliotibial band syndrome. 1 In the general population, the prevalence of bilateral cavus foot is 8~15%. 2 This condition is attributable to peripheral polyneuropathies that are inherited (Charcot-Marie-Tooth disease) or acquired, imposed by central nervous system disorders (poliomyelitis) or traumatic injuries. 2,3 However, most cases appear to be idiopathic. 2
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