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Dysphagia May Be an Independent Marker of Poor Outcome in Acute Lateral Medullary Infarction.

Kim TJ, Nam H, Hong JH, Yeo MJ, Chang JY, Jeong JH, Kim BJ, Bae HJ, Ahn JY, Kim JS, Han MK - J Clin Neurol (2015)

Bottom Line: Older age, hypertension, dysphagia, requirement for intensive care, and pneumonia were significantly more prevalent in the unfavorable outcome group.The frequencies of intensive care (13%) and mortality (16.7%) were significantly higher in the rostral lesion (p=0.002 and p=0.002).These results suggest that older age and initial dysphagia in the acute phase are independent risk factors for poor long-term prognosis after acute LMI.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.

ABSTRACT

Background and purpose: The functional recovery after the lateral medullary infarction (LMI) is usually good. Little is known about the prognostic factors associated with poor outcome following acute LMI. The aim of this study was to identify the factors associated with poor long-term outcome after acute LMI, based on experiences at a single center over 11 years.

Methods: A consecutive series of 157 patients with acute LMI who were admitted within 7 days after symptom onset was evaluated retrospectively. Clinical symptoms were assessed within 1 day after admission, and outcomes were evaluated over a 1-year period after the initial event. The lesions were classified into three vertical types (rostral, middle, and caudal), and the patients were divided into two groups according to the outcome at 1 year: favorable [modified Rankin Scale (mRS) score ≤1] and unfavorable (mRS score ≥2).

Results: Of the 157 patients, 93 (59.2%) had a favorable outcome. Older age, hypertension, dysphagia, requirement for intensive care, and pneumonia were significantly more prevalent in the unfavorable outcome group. The frequencies of intensive care (13%) and mortality (16.7%) were significantly higher in the rostral lesion (p=0.002 and p=0.002). Conditional logistic regression analysis revealed that older age and initial dysphagia were independently related to an unfavorable outcome at 1 year [odds ratio (OR)=1.04, 95% confidence interval (95% CI)=1.001-1.087, p=0.049; OR=2.46, 95% CI=1.04-5.84, p=0.041].

Conclusions: These results suggest that older age and initial dysphagia in the acute phase are independent risk factors for poor long-term prognosis after acute LMI.

No MeSH data available.


Related in: MedlinePlus

Diffusion-weighted (A, C, E) and T2-weighted (B, D, F) MRI showing vertical lateral medullary infarction lesions in the rostral (A, B), middle (C, D), and caudal (E, F) medulla.
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Figure 1: Diffusion-weighted (A, C, E) and T2-weighted (B, D, F) MRI showing vertical lateral medullary infarction lesions in the rostral (A, B), middle (C, D), and caudal (E, F) medulla.

Mentions: Brain MRI/MR angiography (MRA) and conventional angiography were used to assess the LMI lesion and dissection of the VA and PICA. Brain MRI/MRA was performed using a 1.5-T or 3.0-T superconducting magnet system. VA or PICA dissections were defined as images of a 'double lumen,' 'intimal flap,' 'string-of-pearls appearance,' 'steno-occlusion,' and 'fusiform aneurysmal dilatation' on either brain MRI/MRA or conventional angiography.22 Based on previous reports, the LMI lesions were classified into three categories: rostral, middle, and caudal (Fig. 1).523 Two board-certified experts in neurology who were blinded to the clinical characteristics retrospectively reviewed and classified the findings on brain MRI/MRA and conventional angiography.


Dysphagia May Be an Independent Marker of Poor Outcome in Acute Lateral Medullary Infarction.

Kim TJ, Nam H, Hong JH, Yeo MJ, Chang JY, Jeong JH, Kim BJ, Bae HJ, Ahn JY, Kim JS, Han MK - J Clin Neurol (2015)

Diffusion-weighted (A, C, E) and T2-weighted (B, D, F) MRI showing vertical lateral medullary infarction lesions in the rostral (A, B), middle (C, D), and caudal (E, F) medulla.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596108&req=5

Figure 1: Diffusion-weighted (A, C, E) and T2-weighted (B, D, F) MRI showing vertical lateral medullary infarction lesions in the rostral (A, B), middle (C, D), and caudal (E, F) medulla.
Mentions: Brain MRI/MR angiography (MRA) and conventional angiography were used to assess the LMI lesion and dissection of the VA and PICA. Brain MRI/MRA was performed using a 1.5-T or 3.0-T superconducting magnet system. VA or PICA dissections were defined as images of a 'double lumen,' 'intimal flap,' 'string-of-pearls appearance,' 'steno-occlusion,' and 'fusiform aneurysmal dilatation' on either brain MRI/MRA or conventional angiography.22 Based on previous reports, the LMI lesions were classified into three categories: rostral, middle, and caudal (Fig. 1).523 Two board-certified experts in neurology who were blinded to the clinical characteristics retrospectively reviewed and classified the findings on brain MRI/MRA and conventional angiography.

Bottom Line: Older age, hypertension, dysphagia, requirement for intensive care, and pneumonia were significantly more prevalent in the unfavorable outcome group.The frequencies of intensive care (13%) and mortality (16.7%) were significantly higher in the rostral lesion (p=0.002 and p=0.002).These results suggest that older age and initial dysphagia in the acute phase are independent risk factors for poor long-term prognosis after acute LMI.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.

ABSTRACT

Background and purpose: The functional recovery after the lateral medullary infarction (LMI) is usually good. Little is known about the prognostic factors associated with poor outcome following acute LMI. The aim of this study was to identify the factors associated with poor long-term outcome after acute LMI, based on experiences at a single center over 11 years.

Methods: A consecutive series of 157 patients with acute LMI who were admitted within 7 days after symptom onset was evaluated retrospectively. Clinical symptoms were assessed within 1 day after admission, and outcomes were evaluated over a 1-year period after the initial event. The lesions were classified into three vertical types (rostral, middle, and caudal), and the patients were divided into two groups according to the outcome at 1 year: favorable [modified Rankin Scale (mRS) score ≤1] and unfavorable (mRS score ≥2).

Results: Of the 157 patients, 93 (59.2%) had a favorable outcome. Older age, hypertension, dysphagia, requirement for intensive care, and pneumonia were significantly more prevalent in the unfavorable outcome group. The frequencies of intensive care (13%) and mortality (16.7%) were significantly higher in the rostral lesion (p=0.002 and p=0.002). Conditional logistic regression analysis revealed that older age and initial dysphagia were independently related to an unfavorable outcome at 1 year [odds ratio (OR)=1.04, 95% confidence interval (95% CI)=1.001-1.087, p=0.049; OR=2.46, 95% CI=1.04-5.84, p=0.041].

Conclusions: These results suggest that older age and initial dysphagia in the acute phase are independent risk factors for poor long-term prognosis after acute LMI.

No MeSH data available.


Related in: MedlinePlus