Objective: To evaluate botulinum toxin treatment of hyperactive upper esophageal sphincter after first-time brainstem stroke. Design: A retrospective study. Subjects: Twelve patients with long standing dysphagia after...Objective: To evaluate botulinum toxin treatment of hyperactive upper esophageal sphincter after first-time brainstem stroke. Design: A retrospective study. Subjects: Twelve patients with long standing dysphagia after brainstem vascular injury admitted to the rehabilitation department of a medical centre. Methods: All patients underwent clinical examination, videofluoroscopic study of swallowing and electromyography. Botulinum toxin was injected percutaneously under electromyographic guide. Outcomes were measured after two weeks and through a long follow up programme, which ranged from two to ten years. Results: A total of 75% of patients (9 of 12) had favourable outcomes. Two patients showed long lasting functional benefits after only one botulinum toxin injection, while seven patients required further treatments to maintain an adequate oral intake. In seven cases it was possible to remove percutaneous endoscopic gastrostomy. No relevant complications were observed. Conclusion: Botulinum toxin can improve severe dysphagia with elective hyperactivity of the upper esophageal sphincter in patients with or without unilateral paresis of the inferior constrictor muscle and in absence of a nuclear involvement of the IXth and Xth cranial nerves. The outcome could be unsatisfactory in the cases of oral phase involvement, bilateral lesion of the inferior constrictor muscle and when there is velopharyngeal insufficiency.展开更多
目的探讨不同类型人工辅助咳嗽(manually assisted coughing,MAC)技术对脑干卒中患者咳嗽功能、痰液清除能力及肺功能的影响,为卒中后咳嗽功能障碍的康复干预提供临床依据。方法采用前瞻性随机对照设计,连续纳入2023年5月—2024年5月于...目的探讨不同类型人工辅助咳嗽(manually assisted coughing,MAC)技术对脑干卒中患者咳嗽功能、痰液清除能力及肺功能的影响,为卒中后咳嗽功能障碍的康复干预提供临床依据。方法采用前瞻性随机对照设计,连续纳入2023年5月—2024年5月于北京小汤山医院运动康复科住院的脑干卒中患者,将其随机分为膈肌刺激组、气管刺激组和舌根刺激组。3组患者均接受常规康复治疗及呼吸训练,在此基础上,各组分别接受膈肌刺激、气管刺激或舌根刺激干预,每日2次,每次30 min,每周5 d,持续2周。干预前、后采用便携式肺功能检测仪测量峰值咳嗽流量(peak cough flow,PCF),检测24 h痰液量,通过运动心肺功能测试系统检测用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in one second,FEV1)、呼气流量峰值(peak expiratory flow,PEF)等静态肺功能指标,并使用超声评估吸气末膈肌厚度(diaphragm thickness at the end of inspiration,TEI)、呼气末膈肌厚度(diaphragm thickness at the end of expiration,TEE)、膈肌厚度分数(diaphragm thickness fraction,DTF)、膈肌移动度(diaphragmatic mobility,DM)等膈肌参数。记录干预后肺炎发生率。结果共纳入33例脑干卒中患者,每组11例。干预后,3组患者的PCF、FVC、FEV1、PEF、TEI、TEE及DTF较干预前均显著提高(均P<0.05),24 h痰液量显著降低(P<0.05)。干预后组间两两比较显示,舌根刺激组的24 h痰液量改善效果优于膈肌刺激组[(35.64±10.71)mL vs.(46.09±9.52)mL,P=0.025];舌根刺激组与气管刺激组的FVC、FEV1、PEF均优于膈肌刺激组(均P<0.05)。干预后3组在PCF、TEI、TEE、DTF等方面的差异均无统计学意义。干预后膈肌刺激组的肺炎发生率为36.4%,气管刺激组为18.2%,舌根刺激组为9.1%,组间差异无统计学意义(P=0.439)。结论膈肌刺激、气管刺激和舌根刺激3种MAC技术均可有效改善脑干卒中患者的咳嗽功能、肺功能及痰液清除能力,其中舌根刺激在诱发咳嗽反射和改善排痰方面的效果更佳。展开更多
Introduction: Autonomic nuclei affection results in variations in hemodynamics, temperature, sweating and ECG. Medullary strokes are challenging in their presentation, bizarre clinical signs, work and neurological out...Introduction: Autonomic nuclei affection results in variations in hemodynamics, temperature, sweating and ECG. Medullary strokes are challenging in their presentation, bizarre clinical signs, work and neurological outcome. The commonest cause is infarction of the posterior inferior cerebellar artery (PICA). Anatomical areas affected include the inferior cerebellar peduncle, dorsolateral medulla, nuclei of the Trigeminal, vestibular nuclei, Ninth and Vagus nerves. The descending sympathetic tracts and spin thalamic tracts. Serious cardiopulmonary events can complicate 11% of cases. Case Presentation: A middle-aged female developed sub-acute dizziness associated with vomiting and right head pains. She was unable to walk but remained cognitively clear. Her gastrointestinal symptoms were disabling and this was the main factor for presenting to the emergency room. The risk factors included hypertension and diabetes mellitus. Imaging studies were essential for posterior circulation stroke diagnosis and follow-up. She manifested remarkable autonomic features regarding the skin and hemodynamics. Nevertheless, the hospital course was controllable. Discussion: This case report was consistent with relevant literature in the contra lateral vaso motor changes and drop in body temperature during the acute phase. Moreover, our patient developed clinical and radiological extension through double antiplatelets. Superiority of the magnetic resonance imaging (MRI) scans in this patient enabled better diagnostic accuracy in a brainstem stroke. Conclusion: The autonomic features, in this case, represent major symptomatology and clinical signs. The variation in the hemodynamics and persistence of symptoms is thought provoking. This increases the awareness of emergency doctors for acute stroke presenting with autonomic features will enable early detection and helps outcome.展开更多
文摘Objective: To evaluate botulinum toxin treatment of hyperactive upper esophageal sphincter after first-time brainstem stroke. Design: A retrospective study. Subjects: Twelve patients with long standing dysphagia after brainstem vascular injury admitted to the rehabilitation department of a medical centre. Methods: All patients underwent clinical examination, videofluoroscopic study of swallowing and electromyography. Botulinum toxin was injected percutaneously under electromyographic guide. Outcomes were measured after two weeks and through a long follow up programme, which ranged from two to ten years. Results: A total of 75% of patients (9 of 12) had favourable outcomes. Two patients showed long lasting functional benefits after only one botulinum toxin injection, while seven patients required further treatments to maintain an adequate oral intake. In seven cases it was possible to remove percutaneous endoscopic gastrostomy. No relevant complications were observed. Conclusion: Botulinum toxin can improve severe dysphagia with elective hyperactivity of the upper esophageal sphincter in patients with or without unilateral paresis of the inferior constrictor muscle and in absence of a nuclear involvement of the IXth and Xth cranial nerves. The outcome could be unsatisfactory in the cases of oral phase involvement, bilateral lesion of the inferior constrictor muscle and when there is velopharyngeal insufficiency.
文摘目的探讨不同类型人工辅助咳嗽(manually assisted coughing,MAC)技术对脑干卒中患者咳嗽功能、痰液清除能力及肺功能的影响,为卒中后咳嗽功能障碍的康复干预提供临床依据。方法采用前瞻性随机对照设计,连续纳入2023年5月—2024年5月于北京小汤山医院运动康复科住院的脑干卒中患者,将其随机分为膈肌刺激组、气管刺激组和舌根刺激组。3组患者均接受常规康复治疗及呼吸训练,在此基础上,各组分别接受膈肌刺激、气管刺激或舌根刺激干预,每日2次,每次30 min,每周5 d,持续2周。干预前、后采用便携式肺功能检测仪测量峰值咳嗽流量(peak cough flow,PCF),检测24 h痰液量,通过运动心肺功能测试系统检测用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in one second,FEV1)、呼气流量峰值(peak expiratory flow,PEF)等静态肺功能指标,并使用超声评估吸气末膈肌厚度(diaphragm thickness at the end of inspiration,TEI)、呼气末膈肌厚度(diaphragm thickness at the end of expiration,TEE)、膈肌厚度分数(diaphragm thickness fraction,DTF)、膈肌移动度(diaphragmatic mobility,DM)等膈肌参数。记录干预后肺炎发生率。结果共纳入33例脑干卒中患者,每组11例。干预后,3组患者的PCF、FVC、FEV1、PEF、TEI、TEE及DTF较干预前均显著提高(均P<0.05),24 h痰液量显著降低(P<0.05)。干预后组间两两比较显示,舌根刺激组的24 h痰液量改善效果优于膈肌刺激组[(35.64±10.71)mL vs.(46.09±9.52)mL,P=0.025];舌根刺激组与气管刺激组的FVC、FEV1、PEF均优于膈肌刺激组(均P<0.05)。干预后3组在PCF、TEI、TEE、DTF等方面的差异均无统计学意义。干预后膈肌刺激组的肺炎发生率为36.4%,气管刺激组为18.2%,舌根刺激组为9.1%,组间差异无统计学意义(P=0.439)。结论膈肌刺激、气管刺激和舌根刺激3种MAC技术均可有效改善脑干卒中患者的咳嗽功能、肺功能及痰液清除能力,其中舌根刺激在诱发咳嗽反射和改善排痰方面的效果更佳。
文摘Introduction: Autonomic nuclei affection results in variations in hemodynamics, temperature, sweating and ECG. Medullary strokes are challenging in their presentation, bizarre clinical signs, work and neurological outcome. The commonest cause is infarction of the posterior inferior cerebellar artery (PICA). Anatomical areas affected include the inferior cerebellar peduncle, dorsolateral medulla, nuclei of the Trigeminal, vestibular nuclei, Ninth and Vagus nerves. The descending sympathetic tracts and spin thalamic tracts. Serious cardiopulmonary events can complicate 11% of cases. Case Presentation: A middle-aged female developed sub-acute dizziness associated with vomiting and right head pains. She was unable to walk but remained cognitively clear. Her gastrointestinal symptoms were disabling and this was the main factor for presenting to the emergency room. The risk factors included hypertension and diabetes mellitus. Imaging studies were essential for posterior circulation stroke diagnosis and follow-up. She manifested remarkable autonomic features regarding the skin and hemodynamics. Nevertheless, the hospital course was controllable. Discussion: This case report was consistent with relevant literature in the contra lateral vaso motor changes and drop in body temperature during the acute phase. Moreover, our patient developed clinical and radiological extension through double antiplatelets. Superiority of the magnetic resonance imaging (MRI) scans in this patient enabled better diagnostic accuracy in a brainstem stroke. Conclusion: The autonomic features, in this case, represent major symptomatology and clinical signs. The variation in the hemodynamics and persistence of symptoms is thought provoking. This increases the awareness of emergency doctors for acute stroke presenting with autonomic features will enable early detection and helps outcome.
