PDF(Pubmed)
Abstract：
OBJECTIVE: Swallowing is a complex task, moderated by a sophisticated bilateral network including multiple supratentorial regions, the brainstem and the cerebellum. To date, conflicting data exist about whether focal lesions to the cerebellum are associated with dysphagia. Therefore, the aim of the study was to evaluate dysphagia prevalence, recovery and dysphagia pattern in patients with ischaemic cerebellar stroke.
METHODS: A retrospective analysis of patients consecutively admitted to an academic stroke centre with ischaemic stroke found only in the cerebellum was performed. The presence of dysphagia was the primary end-point and was assessed by a speech-language pathologist, according to defined criteria. Dysphagia pattern was evaluated by analysing the videos of the flexible endoscopic evaluation of swallowing. Brain imaging was used to identify lesion size and location associated with dysphagia.
RESULTS: Between January 2016 and December 2021, 102 patients (35.3% female) with a mean age of 52.8 ± 17.3 years were included. Thirteen (12.7%) patients presented with dysphagia. The most frequently observed flexible endoscopic evaluation of swallowing phenotype was premature spillage (n = 7; 58.3%), whilst significant residues or aspiration did not occur. One patient died (7.7%); the other patients showed improvement of dysphagia and one patient (7.7%) was discharged with dietary restrictions.
CONCLUSIONS: Although the involvement of the cerebellum in deglutition has become increasingly evident, isolated lesions to the cerebellum are less likely to cause clinically relevant and persisting dysphagia compared to other brain regions. The observed dysphagia pattern shows a lack of coordination and control, resulting in premature spillage or fragmented bolus transfer in some patients.
METHODS: A retrospective analysis of patients consecutively admitted to an academic stroke centre with ischaemic stroke found only in the cerebellum was performed. The presence of dysphagia was the primary end-point and was assessed by a speech-language pathologist, according to defined criteria. Dysphagia pattern was evaluated by analysing the videos of the flexible endoscopic evaluation of swallowing. Brain imaging was used to identify lesion size and location associated with dysphagia.
RESULTS: Between January 2016 and December 2021, 102 patients (35.3% female) with a mean age of 52.8 ± 17.3 years were included. Thirteen (12.7%) patients presented with dysphagia. The most frequently observed flexible endoscopic evaluation of swallowing phenotype was premature spillage (n = 7; 58.3%), whilst significant residues or aspiration did not occur. One patient died (7.7%); the other patients showed improvement of dysphagia and one patient (7.7%) was discharged with dietary restrictions.
CONCLUSIONS: Although the involvement of the cerebellum in deglutition has become increasingly evident, isolated lesions to the cerebellum are less likely to cause clinically relevant and persisting dysphagia compared to other brain regions. The observed dysphagia pattern shows a lack of coordination and control, resulting in premature spillage or fragmented bolus transfer in some patients.
摘要：
目的：吞咽是一项复杂的任务，由包括多个幕上区域的复杂双边网络主持，脑干和小脑.迄今为止,关于小脑局灶性病变是否与吞咽困难相关,存在相互矛盾的数据.因此,这项研究的目的是评估吞咽困难的患病率，缺血性小脑卒中患者的恢复和吞咽困难模式。
方法：对仅在小脑发现的缺血性卒中患者连续入院进行回顾性分析。吞咽困难的存在是主要终点，由言语病理学家评估，根据定义的标准。通过分析柔性内窥镜吞咽评估的视频来评估吞咽困难模式。脑成像用于确定与吞咽困难相关的病变大小和位置。
结果：在2016年1月至2021年12月之间，纳入了102例患者（35.3%为女性），平均年龄为52.8±17.3岁。13例（12.7％）患者出现吞咽困难。最常见的柔性内镜下吞咽表型评估是过早溢出（n=7;58.3％），而没有发生明显的残留或误吸。一名患者死亡（7.7％）；其他患者表现出吞咽困难的改善，一名患者（7.7％）因饮食限制而出院。
结论：尽管小脑参与吞咽的作用越来越明显，与其他大脑区域相比，小脑的孤立病变不太可能引起临床相关和持续的吞咽困难。观察到的吞咽困难模式显示缺乏协调和控制，导致一些患者过早溢出或支离破碎的推注转移。
方法：对仅在小脑发现的缺血性卒中患者连续入院进行回顾性分析。吞咽困难的存在是主要终点，由言语病理学家评估，根据定义的标准。通过分析柔性内窥镜吞咽评估的视频来评估吞咽困难模式。脑成像用于确定与吞咽困难相关的病变大小和位置。
结果：在2016年1月至2021年12月之间，纳入了102例患者（35.3%为女性），平均年龄为52.8±17.3岁。13例（12.7％）患者出现吞咽困难。最常见的柔性内镜下吞咽表型评估是过早溢出（n=7;58.3％），而没有发生明显的残留或误吸。一名患者死亡（7.7％）；其他患者表现出吞咽困难的改善，一名患者（7.7％）因饮食限制而出院。
结论：尽管小脑参与吞咽的作用越来越明显，与其他大脑区域相比，小脑的孤立病变不太可能引起临床相关和持续的吞咽困难。观察到的吞咽困难模式显示缺乏协调和控制，导致一些患者过早溢出或支离破碎的推注转移。
