Objective: To evaluate botulinum toxin treatment of hyperactive upper esophageal sphincter after first-time brainstem stroke. Design: A retrospective study. Subjects: Twelve patients with long standing dysphagia after...Objective: To evaluate botulinum toxin treatment of hyperactive upper esophageal sphincter after first-time brainstem stroke. Design: A retrospective study. Subjects: Twelve patients with long standing dysphagia after brainstem vascular injury admitted to the rehabilitation department of a medical centre. Methods: All patients underwent clinical examination, videofluoroscopic study of swallowing and electromyography. Botulinum toxin was injected percutaneously under electromyographic guide. Outcomes were measured after two weeks and through a long follow up programme, which ranged from two to ten years. Results: A total of 75% of patients (9 of 12) had favourable outcomes. Two patients showed long lasting functional benefits after only one botulinum toxin injection, while seven patients required further treatments to maintain an adequate oral intake. In seven cases it was possible to remove percutaneous endoscopic gastrostomy. No relevant complications were observed. Conclusion: Botulinum toxin can improve severe dysphagia with elective hyperactivity of the upper esophageal sphincter in patients with or without unilateral paresis of the inferior constrictor muscle and in absence of a nuclear involvement of the IXth and Xth cranial nerves. The outcome could be unsatisfactory in the cases of oral phase involvement, bilateral lesion of the inferior constrictor muscle and when there is velopharyngeal insufficiency.展开更多
Introduction: Autonomic nuclei affection results in variations in hemodynamics, temperature, sweating and ECG. Medullary strokes are challenging in their presentation, bizarre clinical signs, work and neurological out...Introduction: Autonomic nuclei affection results in variations in hemodynamics, temperature, sweating and ECG. Medullary strokes are challenging in their presentation, bizarre clinical signs, work and neurological outcome. The commonest cause is infarction of the posterior inferior cerebellar artery (PICA). Anatomical areas affected include the inferior cerebellar peduncle, dorsolateral medulla, nuclei of the Trigeminal, vestibular nuclei, Ninth and Vagus nerves. The descending sympathetic tracts and spin thalamic tracts. Serious cardiopulmonary events can complicate 11% of cases. Case Presentation: A middle-aged female developed sub-acute dizziness associated with vomiting and right head pains. She was unable to walk but remained cognitively clear. Her gastrointestinal symptoms were disabling and this was the main factor for presenting to the emergency room. The risk factors included hypertension and diabetes mellitus. Imaging studies were essential for posterior circulation stroke diagnosis and follow-up. She manifested remarkable autonomic features regarding the skin and hemodynamics. Nevertheless, the hospital course was controllable. Discussion: This case report was consistent with relevant literature in the contra lateral vaso motor changes and drop in body temperature during the acute phase. Moreover, our patient developed clinical and radiological extension through double antiplatelets. Superiority of the magnetic resonance imaging (MRI) scans in this patient enabled better diagnostic accuracy in a brainstem stroke. Conclusion: The autonomic features, in this case, represent major symptomatology and clinical signs. The variation in the hemodynamics and persistence of symptoms is thought provoking. This increases the awareness of emergency doctors for acute stroke presenting with autonomic features will enable early detection and helps outcome.展开更多
文摘Objective: To evaluate botulinum toxin treatment of hyperactive upper esophageal sphincter after first-time brainstem stroke. Design: A retrospective study. Subjects: Twelve patients with long standing dysphagia after brainstem vascular injury admitted to the rehabilitation department of a medical centre. Methods: All patients underwent clinical examination, videofluoroscopic study of swallowing and electromyography. Botulinum toxin was injected percutaneously under electromyographic guide. Outcomes were measured after two weeks and through a long follow up programme, which ranged from two to ten years. Results: A total of 75% of patients (9 of 12) had favourable outcomes. Two patients showed long lasting functional benefits after only one botulinum toxin injection, while seven patients required further treatments to maintain an adequate oral intake. In seven cases it was possible to remove percutaneous endoscopic gastrostomy. No relevant complications were observed. Conclusion: Botulinum toxin can improve severe dysphagia with elective hyperactivity of the upper esophageal sphincter in patients with or without unilateral paresis of the inferior constrictor muscle and in absence of a nuclear involvement of the IXth and Xth cranial nerves. The outcome could be unsatisfactory in the cases of oral phase involvement, bilateral lesion of the inferior constrictor muscle and when there is velopharyngeal insufficiency.
文摘Introduction: Autonomic nuclei affection results in variations in hemodynamics, temperature, sweating and ECG. Medullary strokes are challenging in their presentation, bizarre clinical signs, work and neurological outcome. The commonest cause is infarction of the posterior inferior cerebellar artery (PICA). Anatomical areas affected include the inferior cerebellar peduncle, dorsolateral medulla, nuclei of the Trigeminal, vestibular nuclei, Ninth and Vagus nerves. The descending sympathetic tracts and spin thalamic tracts. Serious cardiopulmonary events can complicate 11% of cases. Case Presentation: A middle-aged female developed sub-acute dizziness associated with vomiting and right head pains. She was unable to walk but remained cognitively clear. Her gastrointestinal symptoms were disabling and this was the main factor for presenting to the emergency room. The risk factors included hypertension and diabetes mellitus. Imaging studies were essential for posterior circulation stroke diagnosis and follow-up. She manifested remarkable autonomic features regarding the skin and hemodynamics. Nevertheless, the hospital course was controllable. Discussion: This case report was consistent with relevant literature in the contra lateral vaso motor changes and drop in body temperature during the acute phase. Moreover, our patient developed clinical and radiological extension through double antiplatelets. Superiority of the magnetic resonance imaging (MRI) scans in this patient enabled better diagnostic accuracy in a brainstem stroke. Conclusion: The autonomic features, in this case, represent major symptomatology and clinical signs. The variation in the hemodynamics and persistence of symptoms is thought provoking. This increases the awareness of emergency doctors for acute stroke presenting with autonomic features will enable early detection and helps outcome.
