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Objective To investigate the effect of intermittent oro-esophageal rube feeding (IOE) on dysphagia in acute stroke patients with bulbar or pseudobulbar palsy.Methods From May 2016 to December 2018,patients with acute stroke complicated with bulbar or pseudobulbar palsy admitted to the Department of Neurobgy,Ninghe District Hospital of Tianjin were enrolled retrospectively.They were divided into IOE group and nasogastric gavage tube (NGT) group.The baseline clinical data,swallowing function and nutritional indicators before and after treatment,and the incidence of aspiration pneumonia were collected and compared.Kubota's water swallow test was used to evaluate the swallowing function,and Grade ≥ 3 was defined as poor swallowing function after 30 days of treatment.Multivariate logistic regression analysis was used to determine the independent influencing factors of poor outcomes of swallowing function.Results A total of 92 patients were enrolled,58 were males (63％),and aged 64.3-± 11.2 years;the National Institutes of Health Stroke Scale (NIHSS) score 5.98 ±-2.29;76 patients (82.6％) had cerebral infarction,16 (17.4％) had cerebral hemorrhage;16 (17.4％) had bulbar palsy,and 76 (82.6％) had pseudobulbar palsy.There were 46 cases in each of the IOE group and the NGT group.The improvement of swallowing function and nutritional status at 30 d in the IOE group were significantly better than those in the NGT group (all P ＜0.01),while the incidence of aspiration pneumonia was significantly lower than that in the NGT group (19.6％ vs.39.1％;x2 =4.246,P =0.039).The dysphagia of 70 patients (76.1％) had good outcomes,and that of 22 (23.9％) had poor outcomes.Multivariate logistic regression analysis showed that the NIHSS score on admission (odds ratio [OR] 1.225,95％ confidence interval [CI] 1.221-1.445;P=0.030),bulbar palsy (OR 1.428,95％ CI 1.327-1.545;P＜0.001),and left lesions (OR 1.424,95％ CI 1.352-1.565;P＜0.001) were independently associated with the poor outcomes of swallowing function,while IOE (OR 0.351,95％ CI 0.075-0.643;P ＜0.001) was independently associated with the good outcomes of swallowing function.Conclusion IOE can improve the swallowing function of stroke patients with bulbar or pseudobulbar palsy,and reduce the incidence of aspiration pneumonia while providing good nutritional support.
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Objective:To explore the effect of CT-guided Botulinum toxin injection into cricopharynx muscle on dysphagia caused by true bulbar palsy. Methods:A case of dysphagia caused by true bulbar palsy was treated with CT-guided Botulinum toxin injection and its therapeutic effect was reported. Results:The patient had dysphagia after brainstem infarction and was diagnosed as true bulbar palsy. After routine rehabilitation of dysphagia and balloon dilatation, her dysphagia relieved, but reappeared three times. Botulinum toxin was injected into the loop pharynx muscle under the guidance of CT, the clinical effect was remarkable, and no recurrence of the disease appeared in the follow-up. Conclusion:CT-guided Botulinum toxin injection into cricopharyngeus is effective on dysphagia caused by true medullary palsy, and the probability of recurrence is small.
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'Ten Acupuncture Skills' refers to ten types of needling techniques for difficult and intractable neurological diseases. It has been summarized by Prof. Gao Wei-bin, a famous traditional Chinese medicine expert in China, based upon his clinical experience for years, including neck acupuncture for bulbar palsy, neck acupuncture for laryngeal muscular paralysis, stuck needling technique for ocular muscular paralysis, electric field therapy at Jiaji (EX-B 2) points for incomplete spinal paraplegia, electroacupuncture (EA) for urination disorder, electric neck acupuncture for waking up and treating various cerebral and nuchal diseases, EA at Jiaji (EX-B 2) points for intractable hiccup, EA at Jiaji (EX-B 2) points for cervical and lumbar spondylopathy, antagonistic EA for post-apoplectic hemiplegia, and EA for facial paralysis. The ten acupuncture skills are summarized in order to guide the clinical application.
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Aims: To report a case of pharyngeal-cervical-brachial variant of Guillain-Barré syndrome, which is characterized by rapidly progressivebulbar palsy with upper limb, neck and oropharyngeal involvement. It is a rare disorder in childhood and most cases have been described inadolescents.Case Description: A seven year-old-boy presented with dysarthria, hoarseness, dysphagia, facial diplegia and bilateral progressive upperlimb weakness. These symptoms started two weeks after a gastrointestinal infection. Nerve conduction studies were compatible with an acutedemyelinating polyneuropathy in the upper extremities. Anti-ganglioside antibodies in the serum (anti-GT1a, GD1a, GQ1b) were positiveand Campylobacter jejuni was isolated from stools. The patient was treated with intravenous immunoglobulin and needed ventilatory supportduring the first 12 days of admission. He was discharged at day 15 showing improvement of his neurological deficits. He fully recovered aftereleven months of follow-up.Conclusions: Although pharyngeal-cervical-brachial variant of Guillain-Barré syndrome is uncommon in children, it should be consideredin a child with acute bulbar dysfunction because a timely diagnosis allows the early institution of therapeutic measures that can be lifesaving.
Objetivos: Relatar um caso da variante faringo-cervico-braquial da síndrome de Guillain-Barré, que se caracteriza por paralisia bulbarrapidamente progressiva com envolvimento dos membros superiores, pescoço e região orofaríngea. É um diagnóstico raro na criança, ocorrendoa maioria dos casos em adolescentes.Descrição do Caso: Um menino de sete anos de idade iniciou com queixas de disartria, disfonia, disfagia, diplegia facial e fraqueza muscularprogressiva dos membros superiores. Estes sintomas surgiram duas semanas após uma infeção gastrointestinal. Os estudos eletrofisiológicosforam compatíveis com polineuropatia aguda desmielinizante nos membros superiores. Os anticorpos anti-gangliosídeo no plasma(anti-GT1a, GD1a, GQ1b) foram positivos e Campylobacter jejuni foi isolado nas fezes. O paciente foi tratado com imunoglobulina endovenosae necessitou de suporte ventilatório durante os primeiros 12 dias. Teve alta no 15º dia com melhora dos sintomas neurológicos. Recuperou-setotalmente após 11 meses de seguimento.Conclusões: Apesar da variante faringo-cervico-braquial ser pouco frequente em idade pediátrica, é um diagnóstico que deve ser consideradoperante uma criança com disfunção bulbar aguda, pois a identificação precoce permite instituir rapidamente medidas terapêuticas que podemevitar a morte.
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Myeloid Sarcoma1 (also termed as chloroma, granulocytic sarcoma, extra medullary myeloid tumor) is a rare extra medullary tumor composed of immature myeloid cells (myeloblast)2. It is usually associated with leukemia or other myeloproliferative disorder. Myeloid Sarcoma in the central nervous system, around the brain stem is the commonest site of presentation and require high suspicion for diagnosis. We report a forty years male patient with history of dysphagia, dysphonia for last two months. MRI showed chloromas around the brain stem. Laboratory investigations revealed the presence of AML. This is a rare case of Myeloid Sarcoma around the brain stem in a patient of AML.
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Acute bulbar palsy is considered an extremely rare manifestation of neuromuscular disorder in thyrotoxicosis.It happens abruptly and progresses quickly,sudden onset of dysphagia is common.It will endanger patient's life without proper treatment.The definite treatment of acute bulbar palsy in hyperthyroidism is to restore the euthyroid state.The dysphagia usually resolves within 3 to 4 weeks.In this article a case of thyrotoxicosis with acute bulbar palsy in reported herewith to call attention to the diagnosis and treatment of this disorder.
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It is difficult to make dysphagia assessments in actual meal settings. Therefore, instrument-based evaluations are necessary, and videofluoroscopic examinations (VF) and video-endoscopic examinations (VE) of swallowing are typically performed for this purpose. Much information can be obtained by understanding the respective advantages and disadvantages of VF and VE and combining them for evaluations, making them useful for both assessment and treatment. Essentially, VF is contrast radiography using a fluoroscope. It uses test food containing a contrast agent that allows the flow of the food from the mouth to the pharynx and esophagus accompanying swallowing movements to be observed in real time to determine whether there is aspiration or food remaining in the pharynx. The images are taken mainly from the frontal and lateral views under fluoroscopy. VE is a test that involves direct fiberscopic observation of things such as glottal closure, saliva and secretions, and food boluses or other substances remaining in the pharynx. Assessment includes evaluation of vocal cord paralysis, redness and swelling of the arytenoid region, and whether there is saliva aspiration into the larynx. Next, the swallowing function is assessed using actual food. The body posture used in the test is the individual's regular posture when eating and a safe, proper posture with a low risk of aspiration. Today, VF and VE are essential tools for assessing and treating dysphagia. It is hoped that many practitioners will acquire the skills to administer and make use of these tests in the rehabilitation of patients with eating and swallowing disorders.
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Acute multiple cranial neuropathies are considered as variant of Guillain-Barre syndrome, which are immune-mediated diseases triggered by various cases. It is a rare disease which is related to infectious, inflammatory or systemic diseases. According to previous case reports, those affected can exhibit almost bilateral facial nerve palsy, then followed by bulbar dysfunctions (cranial nerves IX and X) accompanied by limb weakness and walking difficulties due to motor and/or sensory dysfunctions. Furthermore, reported cases of the acute multiple cranial neuropathies show electrophysiological abnormalities compatible with the typical Guillain-Barre syndromes (GBS). We recently experienced a patient with a benign infectious disease who subsequently developed symptoms of variant GBS. Here, we describe the case of a 48-year-old male patient who developed multiple symptoms of cranial neuropathy without limb weakness. His laboratory findings showed a positive result for anti-GQ1b IgG antibody. As compared with previously described variants of GBS, the patient exhibited widespread cranial neuropathy, which included neuropathies of cranial nerves III-XII, without limb involvement or ataxia.
Subject(s)
Humans , Male , Middle Aged , Ataxia , Bulbar Palsy, Progressive , Communicable Diseases , Cranial Nerve Diseases , Cranial Nerves , Extremities , Facial Nerve , Guillain-Barre Syndrome , Immunoglobulin G , Paralysis , Rare Diseases , WalkingABSTRACT
Objective To investigate the influence of swallowing exercise on dysphagia of patients with genuine and false bulbar palsy. Methods Sixty cases with genuine and false bulbar palsy were divided into two groups: rehabilitation exercise group(test group, n =30) and drug group(control group, n =30). Those in the control group were given routine medications and nursing, while those in the test group were given swallowing exercise in addition to the routine treatment. Change of swallowing ability is observed and compared. Results The swallowing ability in the rehabilitation exercise group was better improved than that in the control group. There was significant difference between them ( P