Clinical characteristics of patients with lateral medullary infarction who had fatal respiratory failure

• Published in: Journal of the neurological sciences Vol. 434; p. 120167
• Main Authors: Saito, Takuya, Itabashi, Ryo, Kawabata, Yuichi, Yazawa, Yukako
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.03.2022
• Subjects: Humans; Infarction - complications; Ischemic Stroke; Lateral medullary infarction; Magnetic Resonance Imaging; Medulla Oblongata - diagnostic imaging; Medulla Oblongata - pathology; Respiratory failure; Respiratory Insufficiency - etiology; Respiratory Insufficiency - pathology; Stroke - complications; Respiratory failure; Lateral medullary infarction; Ischemic stroke
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2022.120167

Respiratory failure is a fatal complication of lateral medullary infarction (LMI). However, the clinical characteristics associated with respiratory failure in patients with LMI have not been fully elucidated. We aimed to evaluate the clinical characteristics associated with respiratory failure in patients with LMI. Among the 6365 consecutive patients who were admitted to our institute within 7 days of onset of acute ischemic stroke between January 2007 and December 2019, we identified those with acute LMI as verified by magnetic resonance imaging. We evaluated the associations between clinical characteristics and fatal respiratory failure that occurred within 10 days of stroke onset. Of 102 patients with acute LMI, eight had fatal respiratory failure within 10 days of stroke onset. Patients with fatal respiratory failure had a higher premorbid modified Rankin Scale score than did those without (3 vs. 0, p < 0.001), as well as a higher frequency of pulmonary disease (37.5% vs. 2.1%, p = 0.003). Severe dysphagia (100% vs. 30.9%, p < 0.001), dysarthria (100% vs. 56.4%, p = 0.020), ipsilateral hemiparesis (50.0% vs. 5.3%, p = 0.002), and urinary retention (50.0% vs. 2.1%, p < 0.001) were also significantly more common in patients with fatal respiratory failure than in those without. There were no significant differences in infarct locations between patients with fatal respiratory failure and those without. Assessment of pre-stroke history and monitoring of neurological symptoms that occur during the first 10 days post-stroke onset would be useful for predicting the risk of respiratory failure in patients with acute LMI. •Fatal respiratory failure in lateral medullary infarction patients needs elucidation.•These patients had higher premorbid mRS score and pulmonary disease frequency.•Dysphagia, dysarthria, ipsilateral hemiparesis, urinary retention were more common.•Pre-stroke history and neurological symptoms after stroke onset must be assessed.