Download PDF
Int Arch Otorhinolaryngol 2012; 16(03): 313-321
DOI: 10.7162/S1809-97772012000300003
Original Article
Thieme Publicações Ltda Rio de Janeiro, Brazil

Correlation between brain injury and dysphagia in adult patients with stroke

Maria Cristina de Alencar Nunes
1   Speech Therapist. Student Doctorate in Internal Medicine from the Universidade Federal do Paraná (HC-UFPR). Professor of the Specialization Course on Dysphagia and Voice of the University Tuiuti do Paraná – Curitiba/PR.
,
Ari Leon Jurkiewicz
2   Geriatrician. Doctor of Sciences from the UNIFESP / EPM. Professor of Masters and Doctorate in Communication Disorders at the University Tuiuti - Curitiba/PR.
,
Rosane Sampaio Santos
3   Speech Therapist. Student Doctorate in Internal Medicine from the Universidade Federal do Paraná (HC-UFPR). Professor of Masters and Doctorate in Communication Disorders at the University Tuiuti - Curitiba/PR.
,
Ana Maria Furkim
4   Speech Therapist. Doctor in Human Communication Disorders from the Federal University of Sao Paulo. Professor of Speech Pathology, Federal University of Santa Catarina/SC.
,
Giselle Massi
5   Speech Therapist. Doctor in Linguistics from the Universidade Federal do Paraná (UFPR). Professor of Masters and Doctorate in Communication Disorders at the University Tuiuti - Curitiba/PR.
,
Gisele Sant Ana Pinto
6   Speech Therapist. Student Master in Internal Medicine from the Universidade Federal do Paraná (HC-UFPR) - Curitiba/PR.
,
Marcos Christiano Lange
7   Neurologist. Doctor in Internal Medicine from the Universidade Federal do Paraná (HC-UFPR) - Curitiba/PR.
› Author Affiliations
Further Information

Publication History

08 October 2011

08 May 2012

Publication Date:
05 December 2013 (online)

   Permissions and Reprints

Summary

Introduction: In the literature, the incidence of oropharyngeal dysphagia in patients with cerebrovascular accident (AVE) ranges 20–90%. Some studies correlate the location of a stroke with dysphagia, while others do not.

Objective: To correlate brain injury with dysphagia in patients with stroke in relation to the type and location of stroke.

Method: A prospective study conducted at the Hospital de Clinicas with 30 stroke patients: 18 women and 12 men. All patients underwent clinical evaluation and swallowing nasolaryngofibroscopy (FEES®), and were divided based on the location of the injury: cerebral cortex, cerebellar cortex, subcortical areas, and type: hemorrhagic or transient ischemic.

Results: Of the 30 patients, 18 had ischemic stroke, 10 had hemorrhagic stroke, and 2 had transient stroke. Regarding the location, 10 lesions were in the cerebral cortex, 3 were in the cerebral and cerebellar cortices, 3 were in the cerebral cortex and subcortical areas, and 3 were in the cerebral and cerebellar cortices and subcortical areas. Cerebral cortex and subcortical area ischemic strokes predominated in the clinical evaluation of dysphagia. In FEES®, decreased laryngeal sensitivity persisted following cerebral cortex and ischemic strokes. Waste in the pharyngeal recesses associated with epiglottic valleculae predominated in the piriform cortex in all lesion areas and in ischemic stroke. A patient with damage to the cerebral and cerebellar cortices from an ischemic stroke exhibited laryngeal penetration and tracheal aspiration of liquid and honey.

Conclusion: Dysphagia was prevalent when a lesion was located in the cerebral cortex and was of the ischemic type.

Keywords

stroke - deglutition disorders - ischemic attack - transient.
 

  • References

  • 1 Benseñor I, Lotufo P. A incidência do acidente vascular cerebral no Brasil. Disponível em: http://saude.hsw.uol.com.br/avc-epidemiologia.htm
    Google Scholar
  • 2 Furkim A, Mattana A. Fisiologia da deglutição orofaríngea. In: Ferreira L, Befi-lopes D, Limonge S. Tratado de fonoaudiologia. 1ª ed. São Paulo: Rocca; 2004. ; pp. 212-218
    Google Scholar
  • 3 Michou E, Hamdy S. Cortical input in control of swallowing. Curr Opin Otolaryngol Head Neck Surg 2009; 17: 166-171
    CrossrefGoogle Scholar
  • 4 Rosado C, Amaral L, Galvão AP, Guerra S, Furia C. Avaliação da disfagia em pacientes pediátricos com traumatismo crânio-encefálico. Rev. CEFAC 2005; 7: 34-41
    Google Scholar
  • 5 ASHA: American Speech and Hearing Association. Model medical review guidelines for dysphagia services [monograph on the Internet] 2004 (Revision to DynCorp 2001 FTRP by ASHA). (cited 2007 Mar 3). Available from: http://www.asha.org/NR/rdonlyres/5771B0F7-D7C0-4D47-832A86FC6FEC2AE0/0/DynCorpDysph
    Google Scholar
  • 6 Palmer J, Duchane A. Rehabilitation of swallowing disorders due to stroke. Phys Med Rehabil Clin N Amer 1991; 2: 529-536
    Google Scholar
  • 7 Pacianori M , et al. Dysphagia following stroke. Euro Neurol 2004; 51: 162-167
    Google Scholar
  • 8 Schelp A, Cola PC, Gatto A, Silva RG, Carvalho L. Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência. Arq Neuropsiquiatr 2004; 62: 503-506
    CrossrefGoogle Scholar
  • 9 Bassi A, Mitre E, Silva M, Arroyo M, Pereira M. Associação entre disfagia e o topodiagnóstico da lesão encefálica pós-acidente vascular encefálico. Rev. CEFAC 2004; 6: 135-142
    Google Scholar
  • 10 Miguel J. Análise comparativa da deglutição no AVE agudo de tronco encefálico e supratentorial. Minas Gerais, 2010, p. 75, (Trabalho de Conclusão de Curso de Fonoaudiologia da Faculdade de Medicina da Universidade Federal de Minas Gerais)
    Google Scholar
  • 11 Xerez D, Carvalho Y, Costa M. Estudo clínico e videofluoroscópico da disfagia na fase subaguda do acidente vascular encefálico. Radiol Bras 2004; 37: 9-14
    Google Scholar
  • 12 O'Sullivan S, Schmitz T. Fisioterapia avaliação e tratamento, 2ª ed. São Paulo: Manole; 1993. , pp. 385
    Google Scholar
  • 13 Hudak C, Gallo B. Cuidados intensivos de enfermagem: uma abordagem holística, 6ª ed. Rio de Janeiro: Guanabara Koogan; 1997
    Google Scholar
  • 14 Marik P. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001; 344: 665-671
    CrossrefPubMedGoogle Scholar
  • 15 American Dietetic Association (ADA). Food and nutrition misinformation: position of ADA. J Am Diet Assoc 2002; 102260-266
    Google Scholar
  • 16 Crary M, Mann G, Groher M. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Am J Phys Med Rehab 2005; 86: 1516-1520
    CrossrefGoogle Scholar
  • 17 Langmore S, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia 1988; 2: 216-219
    Google Scholar
  • 18 Rosenbek J, Robbins J, Roecker E, Coyle J, Woods J. A penetration aspiration scale. Dysphagia 1996; 11: 93-98
    Google Scholar
  • 19 Gomes G. Identificação de fatores preditivos de pneumonia aspirativa em pacientes hospitalizados com doença cerebrovascular complicada por disfagia orofaríngea. Curitiba, 2001, p. 86, (Tese Doutorado - Setor de Ciências da Saúde, da Universidade do Paraná
    Google Scholar
  • 20 Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: Incidence, diagnosis and pulmonary complications. Stroke 2005; 36: 2756-2763
    CrossrefPubMedGoogle Scholar
  • 21 Carr J, Shepherd R. Mudando a face da reabilitação neurológica. Rev Bras Fisioter 2006; 10: 147-156
    CrossrefGoogle Scholar
  • 22 Silvia R. Disfagia neurogênica em adultos pós-acidente vascular encefálico: identificação e classificação. São Paulo, 1997, (Dissertação de Mestrado. São Paulo: Universidade Federal de São Paulo)
    Google Scholar
  • 23 Almeida É. Frequência e fatores relacionados à disfagia orofaríngea após acidente vascular encefálico. Belo Horizonte, 2009, p. 65, (Dissertação apresentada ao Instituto de Ciências Biológicas da Universidade Federal de Minas Gerais)
    Google Scholar
  • 24 Silva RG, Jorge A, Peres F, Cola P, Gatto A, Spadotto A. Protocolo para controle de eficácia terapêutica em disfagia orofaríngea neurogênica (PROCEDON). Rev. CEFAC 2010; 12: 75-81
    CrossrefGoogle Scholar
  • 25 Veis S, Logemann J. Swallowing disorders in persons with cerebrovascular accident. Arch Phys Med Rehabil 1985; 66: 372-375
    PubMedGoogle Scholar
  • 26 Buchholz D, Robbins J. Neurologic diseases affecting oropharingeal swallowing. In: Perlman A, Schulze-delrieu K. Deglutition and its discords. San Diego: Singular Publishing Group; 1997
    Google Scholar
  • 27 Aviv J , et al. Supraglottic and pharyngeal sensory abnormalities in stroke patients with dysphagia. Ann Otol Rhinol Laryngol 1996; 105: 92-97
    Google Scholar
  • 28 Ding R, Logemann J. Pneumonia in stroke patients: a retrospective study. Dysphagia 2000; 15: 51-57
    Google Scholar