J Korean Dysphagia Soc.  2020 Jan;10(1):113-122. 10.34160/jkds.2020.10.1.014.

Characteristics and Risk Factors of Aspiration in Lateral Medullary Infarction

• Kim JS
• Kim HJ
• Kim JY
• Choi HS
• Hong J
• Kim DY

• KMID: 2506399
• DOI: http://doi.org/10.34160/jkds.2020.10.1.014

Abstract

Objective
To evaluate the characteristics of dysphagia and identify the risk factors of bolus aspiration in patients presenting with pure lateral medullary infarction (LMI).
Methods
Between January 2014 and January 2019, 51 post-stroke patients with LMI who underwent a videofluoroscopic swallowing study (VFSS) were enrolled retrospectively, and their medical records and brain magnetic resonance imaging results were reviewed. The VFSS results were evaluated to analyze the swallowing function using the penetration-aspiration scale, functional dysphagia scale, and imaging analysis software.
Results
Bolus aspiration was detected in 21 patients (41.2%). The common abnormal VFSS findings were residue in valleculae (74.5%), delayed triggering of pharyngeal swallow (72.5%), residue in pyriform sinuses (62.7%), delayed pharyngeal transit time (56.9%), reduced laryngeal elevation (51.0%), and coating of the pharyngeal wall (49.0%). The incidence of aspiration was significantly higher in the typical lesions (including the diagonal band-shaped lesions) and the large type lesions extending ventrally or dorsally, as compared to other lesion types (P＜0.05). Logistic regression analyses revealed that the residue in pyriform sinuses is a significant independent risk factor of aspiration in the puree trial, and prolonged pharyngeal delay time (PDT) and residue in valleculae are significant risk factors in the thin liquid trial (P＜0.05).
Conclusion
Considering all clinical factors, lesion locations, and swallowing processes, results of the current study indicate that residue in pyriform sinuses is an independent risk factor of aspiration in the swallowing puree technique, whereas prolonged PDT and residue in valleculae are independent risk factors of aspiration in the swallowing liquid technique.

Keyword

Dysphagia; Aspiration; Lateral medullary infarction