Relationship between Lesion Sites of Stroke and Swallowing Function / 中国康复理论与实践

Objective To explore the relationship between lesion sites of stroke and swallowing function. Methods Ischemic stroke pa-tients consecutively admitted into the stroke unit were screened in this study. The new and previous lesion sites of stroke, dysphagia and aspi-ration under videofluoroscopy (VF) were recorded and their relation was analyzed. Results 211 patients were included and 169 patients had completed the MRI and VF examination. 159 patients had dysphagia and 94 had aspiration under VF. 72 patients (9 missing) were found dis-order in oral phase and 150 in pharyngeal phase. There was no significantly difference in dysphagia under VF and in aspiration among differ-ent lesion sites (P>0.05). Patients with stroke in medulla tended to happen aspiration (P=0.056). Stroke sites above the tentorium of cerebel-lum (P=0.028) or above medulla (P=0.005) may cause disorder in oral phase. Conclusion The stroke injury in brain cortex, white matter, brainstem and cerebellum or hemisphere could lead to dysphagia and aspiration. The injury of medulla may cause aspiration. Lesion of brain hemisphere or above the medulla could result disorder in oral phase of swallowing.

Motor Recovery in Relation to the Site of Subcortical Stroke Lesions

OBJECTIVE: The purpose of this study was to evaluate the motor recovery of initial and plateau period in the patients with subcortical stroke lesion which were different locations. METHOD: We studied the 42 stroke patients with subcortical lesions who had been admitted to the Department of Rehabilitation Medicine from 1998 to 2000, retrospectively. Patients were divided into four groups according to the information from brain CT or MRI; Group 1: basal ganglia, group 2: anterior limb of internal capsule and/or basal ganglia, group 3: posterior limb of internal capsule and/or basal ganglia and group 4: thalamus only. Quantitative assessments of motor recovery using the Brunnstrom stage and results were correlated with sites of lesion. RESULTS: 1) Brunnstrom stages at initial and plateau period were the highest in the patients with thalamic lesion and the lowest in the patients with posterior limb of internal capsule and/or basal ganglia lesion. The patients with thalamic lesion showed higher stage than the patients with basal ganglia with anterior limb lesion in hand and low extremity (p<0.05). 2) Significant motor recovery was occurred in all patients except the lesion located in thalamus (p<0.05). CONCLUSION: There were significant differences of motor recovery at plateau period in the patients with thalamic lesions comparing with basal ganglia with anterior limb lesion about hands and lower extremities and patients with basal ganglia and/or capsular lesion showed good motor recovery.

Clinical Characteristics of the Poststroke Depression Patient

BACKGROUND & OBJECTIVES: Depression is one of the most common neuropsychiatric sequelae of stroke, and depression is a serious disorder that can compromise the quality of life and overall rehabilitating process. The aim of this study was to investigate the frequency of depression in acute stroke patient and to compare with nondepressive patients in terms of demographic data, lesion site, pathology and the days of hospitalization. METHOD: Total 200 stroke patients admitted in Korea university hospital from Jan. 1993 to Dec. 1994 were included in this study. Data was collected from the medical records retrospectively and analyzed by means of statistics. RESULT: The frequency of depressive episode was 17% (34/200). The pathologic lesion was more frequently located in the right hemisphere (no statistical significance) and patients with depressive episode showed a higher frequency of lesions in anterior areas of the left hemisphere and posterior areas of the right hemisphere. The hospitalization days of depressive group was longer than that of non-depressive group (student t-test, p<.05). The age of depressive group was younger than that of non-depressive group (student t-test, p<.05). There was a positive correlation between the hospitalization days and the severity of depression(r=0.41). There also was a positive correlation between NIH stroke scale and the severity of depression (r=0.4988). CONCLUSION: In patients with depressive episode after acute stroke, it was more frequently developed in right posterior hemispheric lesion and their hospitalization days was longer in the depressive group than in nondepressive patients.