Dysphagia in unilateral cerebral lesions

Meadows, John C.

doi:10.1136/jnnp.36.5.853

Cited by 124 publications

(73 citation statements)

References 7 publications

(4 reference statements)

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“…36 However, it should be noted that dysphagia and aspiration are not limited to vertebrobasilar or bilateral hemispheric stroke but may also be present after unilateral hemispheric infarction. 37 In conclusion, our data underline the remarkable epidemiological and prognostic impact of SAP on treatment and outcome of acute stroke patients in a specialized NICU setting. The considerably high coincidence rate of acute stroke and pneumonia indicates a close pathophysiological link between the diseases.…”

Section: Discussionmentioning

confidence: 61%

Nosocomial Pneumonia After Acute Stroke

Hilker

Poetter

Findeisen

et al. 2003

Stroke

335

141

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Background and Purpose-Pneumonia has been estimated to occur in about one third of patients after acute stroke. Only limited data are available on stroke-associated pneumonia (SAP) in specialized neurological intensive care units (NICUs). Methods-We enrolled 124 patients with acute stroke who were treated at our university hospital NICU in a prospective observational study. Incidence rates and risk factors of SAP and long-term clinical outcome were determined. Results-SAP incidence was 21% with a spectrum of pathogens, which is comparable to previously published data on general ICU patients. Mechanical ventilation, multiple location, and vertebrobasilar stroke, as well as dysphagia and abnormal chest x-ray findings, were identified as risk factors for the disease. SAP patients showed higher mortality rates than nondiseased subjects (acute, 26.9% versus 8.2%; long-term, 35.3% versus 14.3%) and a significantly poorer long-term clinical outcome (Barthel Index, 50.5Ϯ42.4 versus 81.5Ϯ27.8; Rankin Scale, 3.5Ϯ1.7 versus 2.2Ϯ1.6). Conclusions-Our data underline the considerable epidemiological and prognostic impact of SAP for the treatment of acute stroke patients in a specialized NICU setting. They demonstrate that the occurrence of SAP deteriorates clinical outcome in these patients. Our results allow us to identify high-risk stroke patients at time of NICU admission in whom the use of preventive treatment strategies is most promising.

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Section: Discussionmentioning

confidence: 61%

Nosocomial Pneumonia After Acute Stroke

Hilker

Poetter

Findeisen

et al. 2003

Stroke

335

141

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“…Despite intensive oral-motor and feeding therapy the next stage in the sequence of early chewing development, i.e. the acquisition of a combination of alternating vertical and lateral jaw movements, had not been achieved when the patient was re-examined at the age of 6.5 and 7. neurological damage [29,30]. Some of the early cases with postmortem confirmed lesions to the left lower portions of the pre-and postcentral gyri also presented with concomitant buccolabio-lingual apraxia and apraxia of speech [29] but an inherent association between these related forms of apraxia has not been consistently found in later studies [31,32].…”

Section: Case Reportmentioning

confidence: 99%

Mastication Dyspraxia: A Neurodevelopmental Disorder Reflecting Disruption of the Cerebellocerebral Network Involved in Planned Actions

et al. 2012

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link AbstractThis paper reports longitudinal clinical, neurocognitive and neuroradiological findings in an adolescent patient with non-progressive motor and cognitive disturbances consistent with a diagnosis of developmental coordination disorder (DCD). In addition to prototypical DCD, development of mastication was severely impaired while no evidence of swallowing apraxia, dysphagia, sensorimotor disturbances, abnormal tone or impaired general cognition were found. He suffered from bronchopulmonary dysplasia and was ventilated as newborn for 1.5 months. At the age of three months a ventriculoperitoneal shunt was surgically installed because of obstructive hydrocephalus secondary to perinatal intraventricular bleeding. At the age of five, the patient's attempts to masticate were characterized by rough, effortful and laborious biting movements confined to the vertical plane. Solid food particles had a tendency to get struck in his mouth and there was constant spillage. As a substitute for mastication, he moved the unground food with his fingers in a lateral direction to the mandibular and maxillary vestibule to externally manipulate and squeeze the food between cheek and teeth with the palm of his hand. Once the food was sufficiently soft, the bolus was correctly transported by the tongue in posterior direction and normal deglutition took place. Repeat MRI during follow-up disclosed mild structural abnormalities as the sequellae of the perinatal intraventricular bleeding but this could not explain impaired mastication behaviour.Quantified Tc-99m-ECD SPECT, however, revealed decreased perfusion in the left cerebellar hemisphere, as well as in both inferior lateral frontal regions, both motor cortices and the right anterior and lateral temporal areas. Anatomoclinical findings in this patient with DCD not only indicate that the functional integrity of the cerebello-cerebral network is crucially important in the planning and execution of skilled actions, but also seem to show for the first time that mastication deficits may be of true apraxic origin. As a result it is hypothesized that "mastication dyspraxia" may have to be considered as a distinct nosological entity within the group of the developmental dyspraxias following a disruption of the cerebello-cerebral network involved in planned actions.

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“…As early as 1952, it was recognised that the lateral premotor cortex was critical for coordinating the tongue, facial movements and mastication with swallowing [3, 15]. Theories have been suggested along the lines of each hemisphere controlling a separate phase of the deglutition [16, 17], the right hemisphere – the pharyngeal stage, and the left – the oral stage, and that connections between both hemispheres would be essential to ensure synchronisation of the swallow. Not all workers could confirm these findings [18], and more recent work tends to suggest that the cortical influence is more complex [19, 20, 21, 22, 23].…”

Section: Neurological Control Of Swallowingmentioning

confidence: 99%

“…In 1973, Meadows [17]reviewed the literature and concluded that dysphagia following unilateral stroke was the exception rather than the rule and a recent article [50]does not even mention dysphagia as a complication of unilateral hemisphere stroke. It is now accepted that, on the basis of clinical and radiographic studies, unilateral hemisphere strokes can result in dysphagia [16, 43, 44].…”

Section: Stroke and Swallowingmentioning

confidence: 99%

Swallowing and Stroke

Smithard

2002

Cerebrovasc Dis

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The development of imaging techniques such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) scanning has allowed non-invasive imaging of the brain, to a greater detail, that in the past was not possible. These imaging modalities have allowed the study of the cortical control of swallowing both in the healthy volunteers and the stroke patient. It has become increasingly obvious that swallowing is complex and its recovery following stroke even more so. Swallowing is represented in many areas of the hemisphere and is affected in many different ways following stroke. In most, recovery is spontaneous, but in some it is slow or non-existent. Studies using direct and transcranial electrical stimulation and pharmacological agents have shown interesting results in the recovery of swallowing following stroke.

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Dysphagia in unilateral cerebral lesions

Cited by 124 publications

References 7 publications

Nosocomial Pneumonia After Acute Stroke

Nosocomial Pneumonia After Acute Stroke

Mastication Dyspraxia: A Neurodevelopmental Disorder Reflecting Disruption of the Cerebellocerebral Network Involved in Planned Actions

Swallowing and Stroke

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