Clinical and Radiological Characteristics Associated with Respiratory Failure in Unilateral Lateral Medullary Infarction.

Autor: Pavšič K; Department of Vascular Neurology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia. Electronic address: katja.pavsic@kclj.si., Fabjan A; Department of Vascular Neurology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia; Institute of Physiology, Faculty of Medicine, University of Ljubljana, Slovenia., Zgonc V; Department of Vascular Neurology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia., Šurlan Popović K; Clinical Institute of Radiology, University Medical Centre Ljubljana, Slovenia., Pretnar Oblak J; Department of Vascular Neurology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia., Bajrović FF; Department of Vascular Neurology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia; Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Slovenia.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2021 Sep; Vol. 30 (9), pp. 105947. Date of Electronic Publication: 2021 Jun 27.
DOI: 10.1016/j.jstrokecerebrovasdis.2021.105947
Abstrakt: Background: The prognosis for unilateral lateral medullary infarction (ULMI) is generally good but may be aggravated by respiratory failure with fatal outcome. Respiratory failure has been reported in patients with severe bulbar dysfunction and large rostral medullary lesions, but its associated factors have not been systematically studied. We aimed to assess clinical and radiological characteristics associated with respiratory failure in patients with pure acute ULMI.
Materials and Methods: Seventy-one patients (median age 55 years, 59 males) with MRI-confirmed acute pure ULMI were studied retrospectively. Clinical characteristics were assessed and bulbar symptoms were scored using a scale developed for this study. MRI lesions were classified into 4 groups based on their vertical extent (localized/extensive) and the involvement of the open and/or closed medulla. Clinical characteristics, bulbar scores and MRI lesion characteristics were compared between patients with and without respiratory failure.
Results: Respiratory failure occurred in 8(11%) patients. All patients with respiratory failure were male (p = 0.336), had extensive lesions involving the open medulla (p = 0.061), progression of bulbar symptoms (p=0.002) and aspiration pneumonia (p < 0.001). Peak bulbar score (OR, 7.9 [95% CI, 2.3-160.0]; p < 0.001) and older age (OR, 1.2 [95%CI, 1.0-1.6]; p=0.006) were independently associated with respiratory failure.
Conclusions: Extensive damage involving the open/rostral medulla, clinically presenting with severe bulbar dysfunction, in conjunction with factors such as aspiration pneumonia and older age appears to be crucial for the development of respiratory failure in pure ULMI. Further prospective studies are needed to identify other potential risk factors, pathophysiology, and effective preventive measures for respiratory failure in these patients.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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