ABSTRACT
There are many stroke patients who have eating and swallowing problems after stroke, especially in the acute phase. However, little is known about the relationship between lesion, hematoma volume and pattern of dysphagia in hemorrhagic stroke. Accordingly, we evaluated the clinical features of swallowing function in acute cerebral hemorrhage. Four hundred and forty-seven newly diagnosed acute cerebral hemorrhage patients including 183 putamen, 119 thalamus, 30 cerebellum, 25 brainstem, and 90 subcortical hemorrhages were studied. Patients were referred for bedside swallowing assessment (BSA) using the Repetitive Saliva Swallowing Test and the Modified Water Swallowing Test at initial evaluation. Additionally, videofluoroscopy was performed in 129 patients to determine their oral intake status. The type of diet and outcomes were assessed on discharge. As results, most patients with normal BSA were consuming a regular diet on discharge. However, the number of patients who consumed a regular meal amongst the 289 patients with abnormal BSA was very few. Two hundred ten patients were nutritionally managed using enteral feeding. Lesion site and hematoma volume were related to the BSA result and oral intake outcome at discharge. Eating and swallowing dysfunction is not rare in patients with acute cerebral hemorrhage. We therefore recommend that all patients with cerebral hemorrhage should undergo a swallowing assessment and management in the acute stage.
ABSTRACT
Objective : To clarify the characteristics of memory impairment caused by ruptured aneurysm induced subarachnoid hemorrhage, we examined memory function using the auditory verbal learning test (AVLT). Methods : Subjects were 45 patients with subarachnoid hemorrhage caused by ruptured aneurysm in 14 anterior cerebral arteries (ACA), 12 middle cerebral arteries, 7 vertebrobasilar arteries (VA), and 12 internal cerebral arteries. We discussed the scores of short-term memory (STM), total immediate memory (TIM), verbal learning ability (VLA), retroactive interference effect (RI), recognition and learning curve in different portions of ruptured aneurysm. Additionally, we compared them with healthy subjects (HS). Results : The scores of VLA in ACA were lower than that in HS, and the scores of RI in VA were higher than that in HS. There were no difference in STM, TIM and recognition among groups. The learning curve in ACA and VA were flattening in later trials. Conclusion : Because patients after ruptured subarachnoid hemorrhage in ACA and VA have higher rate of memory impairment, we supposed detailed assessment for memory is important.
ABSTRACT
We compared food and water swallowing tests to investigate the reliability of the tests to exclude aspiration following acute stroke. Subjects were 155 patients with cerebral strokes aged between 20.98 years (66.6±12.9 years) and for whom videofluoroscopic examination of swallowing (VF) was performed for swallowing difficulty or suspected swallowing difficulty. Food tests (FTs) using jelly and rice porridge, and a modified water swallowing test (MWST) were evaluated during VF. The results showed fewer occurrences of choking, cough, wet voice and aspiration during the FTs than in the MWST. The sensitivity and specificity of the FTs for aspiration ranged from 80.0% to 83.3% and 25.5% to 41.3%, respectively. The MWST gave a sensitivity of 58.0% and a specificity of 72.4% for aspiration. There were more incidences of silent aspiration in the MWST than in the FTs. However, the validity of the FTs and their positive predictive value were lower than for the MWST. Choking and cough had a significant relation to aspiration in both tests. We recommend that we need to use each of these tests with an understanding of their characteristics and limitations in order to obtain correct findings in stroke patient swallowing assessments.