CoDAS
http://www.codas.periodikos.com.br/article/doi/10.1590/2317-1782/20232021220en
CoDAS
Relato de Caso

Swallowing capacity and gravity of the laryngotracheal aspiration risk in atypical cerebellar stroke: case report

Capacidade de deglutição e gravidade do risco de aspiração laringotraqueal no Acidente Vascular Encefálico atípico em via cerebelar: relato de caso

Sara Virgínia Paiva Santos; Brenda Carla Lima Araújo; Claudia Sordi; Carla Patrícia Hernandez Alves Ribeiro Cesar; Daniela da Costa Maia de Andrade; Thaisa Soares Caldas Batista; Sheila Schneiberg

Downloads: 1
Views: 122

Abstract

This case report aimed to evaluate the swallowing capacity and the severity of the risk of laryngotracheal aspiration of a 52-year-old female patient with atypical and rare stroke, with major injury in the cerebellar pathway. In order to measure swallowing capacity and risk of aspiration a routine clinical assessment used in the speech therapy clinic was performed and two valid clinical tests were used: Massey Bedside Swallowing Screen (MBSS) and Gugging Swallowing Screen (GUSS). After evaluation with the clinical tests, it was observed that the patient had reduced swallowing capacity, performance characterized as pathological, 100% dysfunction in the water swallowing test (MBSS), presence of choking, coughing, change in vocal quality and anterior escape. In the assessment of risk of aspiration with the GUSS, the patient presented moderate dysphagia and risk of laryngotracheal aspiration.This case report demonstrated that moderate dysphagia is found in a stroke patient with lesions that affect the cerebellum. Standardized and validated clinical tests such as GUSS and MBSS should also be used to assess the risk of dysphagia after stroke at ambulatory care.

Keywords

Stroke; Cerebellum; Dysphagia; Deglutition Disorders; Diagnostic Tests; Case Report

Resumo

Esse relato de caso teve o objetivo de avaliar a capacidade de deglutição e a gravidade do risco de aspiração laringotraqueal de uma paciente, 52 anos, com Acidente Vascular Encefálico (AVE) atípico, com comprometimento na via cerebelar. Para mensurar a capacidade de deglutição e do risco de aspiração foram utilizados a avaliação de rotina na clínica de fonoaudiologia e dois testes clínicos validados: o Massey Bedside Swallowing Screen (MBSS) e o Gugging Swallowing Screen (GUSS). Após a avaliação com os testes clínicos, foi observado que a paciente apresentou capacidade de deglutição diminuída, desempenho caracterizado como patológico e de risco, com 100% de alteração no teste de deglutição de água pelo MBSS, presença de engasgo, tosse, alteração na qualidade vocal e escape anterior de alimento. Já na avaliação do risco de aspiração com o GUSS, a paciente apresentou disfagia moderada e com risco de aspiração laringotraqueal. A disfagia pode estar presente em casos de AVE com lesão anatômica comprometendo o cerebelo e suas vias, o que sugere a importância de avaliação específica da deglutição nesses casos. Os testes GUSS e o MBSS podem ser utilizados para avaliação de casos atípicos de AVE em fase ambulatorial, com objetivos de avaliar o risco de aspiração e a capacidade de deglutição.

Palavras-chave

Acidente Vascular Encefálico; Cerebelo; Transtorno de Deglutição; Teste Diagnóstico; Caso Clínico

Referências

  1. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36(12):2756-63. http://dx.doi.org/10.1161/01.STR.0000190056.76543.eb PMid:16269630.
  2. Sasegbon A, Hamdy S. The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia. Neurogastroenterol Motil. 2017;29(11):e13100. http://dx.doi.org/10.1111/nmo.13100 PMid:28547793.
  3. Nund RL, Scarinci NA, Cartmill B, Ward EC, Kuipers P, Porceddu SV. Application of the International Classification of Functioning, Disability and Health (ICF) to people with dysphagia following non-surgical head and neck cancer management. Dysphagia. 2014;29(6):692-703. http://dx.doi.org/10.1007/s00455-014-9563-4 PMid:25098773.
  4. Singh S, Hamdy S. Dysphagia in Stroke patients. Postgrad Med J. 2006;82(968):383-91. http://dx.doi.org/10.1136/pgmj.2005.043281 PMid:16754707.
  5. Loannides K, Tadi P, Naqvi IA. Cerebellar Infarct. Florida: StatPearls Publishing; 2021.
  6. Rosendo BVY, Gonçalves LF, Mituuti CT, Haas P. Fatores associados à disfagia em pacientes com AVC: uma revisão sistemática. Revista Neurociências. 2021;29:1-24. http://dx.doi.org/10.34024/rnc.2021.v29.11940
  7. Daniels SK, Pathak S, Mukhi SV, Stach CB, Morgan RO, Anderson JA. The relationship between lesion localization and dysphagia in acute stroke. Dysphagia. 2017;32(6):777-84. http://dx.doi.org/10.1007/s00455-017-9824-0 PMid:28748320.
  8. Sasegbon A, Hamdy S. The role of the cerebellum in swallowing. Dysphagia. 2023;38(2):497-509. PMid:33675425.
  9. Reed MD, English M, English C, Huff A, Poliacek I, Musselwhite MN, et al. The role of the cerebellum in control of swallow: evidence of inspiratory activity during swallow. Lung. 2019;197(2):235-40. http://dx.doi.org/10.1007/s00408-018-00192-2 PMid:30680516.
  10. Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T, Tugwell P, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2007;89:218-35. http://dx.doi.org/10.1016/j.jclinepi.2017.04.026 PMid:28529185.
  11. Bolzan GP, Christmann MK, Berwig LC, Costa CC, Rocha RM. Contribution of the cervical auscultation in clinical assessment of the oropharyngeal dysphagia. Rev CEFAC. 2013;15(2):455-65. http://dx.doi.org/10.1590/S1516-18462013000200023
  12. Massey R, Jedlicka D. The Massey bedside swallowing screen. J Neurosci Nurs. 2002;34(5):252-8, 257-60. http://dx.doi.org/10.1097/01376517-200210000-00005 PMid:12391741.
  13. Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, et al. Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke. 2007;38(11):2948-52. http://dx.doi.org/10.1161/STROKEAHA.107.483933 PMid:17885261.
  14. Warnecke T, Im S, Kaiser C, Hamacher C, Oelenberg S, Dziewas R. Aspiration and dysphagia screening in acute stroke-the Gugging Swallowing Screen revisited. Eur J Neurol. 2017;24(4):594-601. http://dx.doi.org/10.1111/ene.13251 PMid:28322006.
  15. Park KD, Kim TH, Lee SH. The Gugging Swallowing Screen in dysphagia screening for patients with stroke: a systematic review. Int J Nurs Stud. 2020;107:103588. http://dx.doi.org/10.1016/j.ijnurstu.2020.103588 PMid:32408200.
     
65a85683a953954952721b22 codas Articles

CoDAS

Share this page
Page Sections