中枢神経障害とえん下 脳梗塞急性期からのえん下障害 ９３症例の臨床経過

Abstract

The recovery of 93 patients from the acute phase of dysphagia with newly developed cerebral infarction is reported. The patients were divided into cases of pseudobulbar palsy and cases of bulbar palsy on the basis of MRI images of their brains. 78 of the patients, who had no medullary infarction, were diagnosed as having pseudobulbar palsy. The other 15, who suffered from lateral medullary infarction (so-called Wallenberg's syndrome) were diagnosed as having bulbar palsy. We studied their clinical courses by use of the laryngeal fiberscope and the barium swallow test. Within 4 weeks, 14 patients (15.1%) had recovered sufficiently to eat soft food, and within 4 to 12 weeks 60 patients (64.5%) had recovered to the same extent. However, in 19 cases (20.4%) severe dysphagia persisted for more than twelve weeks, even with intense rehabilitation. Of these, 4 suffered from medullary infarction and the other 15 had multiple lesions. Those patients with pseudobulbar palsy suffered a disturbance at the oral stage but maintained their pharyngeal movements, though they had difficulty in the transition from the oral to the pharyngeal stage. One patient with pseudobulbar palsy had widespread lesions in the lower motor cortex, which resulted in a disturbance at the pharyngeal stage. Those patients with bulbar palsy suffered disturbance to a series of pharyngeal movements, such as laryngeal elevation and pharyngeal constriction. In two serious cases, cricopharyngeal myotomy and laryngeal suspension were performed. In sum, neurological findings and MRI images of the brain are useful for the diagnosis of dysphagia and its prognosis at the acute stage of cerebral infarction.