Ultrasonic evaluation of movement of the diaphragm after acute cerebral infarction.

Abstract

Respiratory dysfunction is an important complication of acute stroke but its mechanisms are poorly understood. Previous indirect assessments suggest that paralysis of the diaphragm occurs contralateral to the cerebral lesion. Diaphragmatic excursion was studied with real time ultrasound during quiet and deep breathing in 50 patients within 72 hours of acute stroke and 40 controls. During quiet breathing, hemidiaphragmatic movements were not significantly different between right hemispheric stroke, left hemispheric stroke, and controls. During deep inspiration, there was a significant bilateral reduction in hemidiaphragmatic excursion in patients with stroke, for both right hemispheric stroke and left hemispheric stroke when compared with controls (both P < 0 001). Thus isolated hemidiaphragmatic paresis does not occur but maximal excursion of the diaphragm is reduced bilaterally in patients with acute stroke. This is a likely contributor to the respiratory dysfunction after acute stroke. (J Neurol Neurosurg Psychiatry 1995;58:738-741)

Feasibility of Early Physical Therapy Program In-Hospital Patients with Acute Ischemic Stroke

“…Impaired respiratory function may be a consequence of weakness or/and postural trunk dysfunction [20,21]. Changes in diaphragmatic movement -higher positioning of the diaphragm and decreased excursion of the paretic side during deep breathing are reported in several studies [11,22]. Jung K et al, [22] report restrictive pulmonary dysfunction and unilateral reduction in motion of the diaphragm during volitional breathing.…”

“…All pulmonary function measurements were taken after three attempts, the best achievement is reported. Assessing diaphragmatic movement by ultrasonography published already [11,12] were applied with Fukuda UF-750 XT ultrasonography system with a 3.5 MHz sector transducer. Symmetric intercostal probe positions were chosen between the midaxillary and midclavicular lines.…”

Ultrasonographic evaluation of diaphragmatic motion.

“…This finding was not seen during quiet respiration. In acute cerebral infarction, Houston et al 22 tion, which would suggest paralysis. This finding has been reported to revert to normal motion in the supine position.…”

Republished: Society for Neuroscience in Anesthesiology and Critical Care Expert Consensus Statement: Anesthetic Management of Endovascular Treatment for Acute Ischemic Stroke*

“…18,19 Patients with acute stroke may become hypoxemic because of altered central regulation of respiration, sleep apnea, weakness of the respiratory muscles, and aspiration. [20][21][22][23][24][25][26] Sleeprelated breathing disorders may be present in 44% to 95% of stroke patients 21,[27][28][29][30] and may contribute to hypoxia during pharmacologically induced sedation. In a randomized controlled trial of sedation for neurointerventional procedures (not including AIS) a 25% incidence of respiratory complications (snoring, airway obstruction, SpO2<90% or respiratory rate <8/min) was reported despite administration of supplemental oxygen.…”