Functional outcome in patients with pontine infarction after acute rehabilitation

Abstract

We examined the clinical features of patients with pontine infarction in the acute stage and the factors affecting functional prognosis and outcome. Lesions, neurological manifestations at initial physical status examinations, cognitive function, swallowing function and outcome [activities of daily living (ADL), status of nutritional intake at discharge and destination after discharge] were evaluated in 68 patients (47 males and 21 females) who had pontine lesions with acute phase cerebral infarction. The mean length of stay was 24.4 days. The symptoms (number of patients) observed included paralysis (50), dysarthria (47), ataxia (18), diplopia (11), dysphagia (49) and poor cognitive performance (37). The types of lesions (number of patients) included lacunar infarcts in the ventral pontine area (15), lacunar infarcts in the dorsal pontine area (13) and large lacunar infarcts (LLIs) (41). After hospital discharge, 23 patients were discharged home, 44 were transferred to another hospital and 1 died. Twenty-three patients were on a regular diet, 22 were receiving a dysphagia diet and 22 were on enteral feeding at discharge. Patients with LLIs more frequently had poor cognitive performance, paralysis, dysphagia at discharge and a tendency for a longer length of stay compared with patients who had lacunar infarct. Most patients who returned home were those who were younger in age, had fewer neurological symptoms, had better cognitive function and ADL performance, and could ingest food. In an acute hospital, age, neurological symptoms, ADL, cognitive function, and dysphagia were considered important factors for determining the outcome in patients with pontine infarction.

Appendix

Repetitive saliva swallowing test (RSST)

The RSST is an assessment of the patient’s potential to swallow saliva. The frequency of swallowing saliva is measured over a 30 s period. Fewer than three swallows in 30 s is considered abnormal [7].

Modified water swallowing test (MWST)

For the MWST, cold water (3 mL) was placed on the floor of the mouth using a 5 mL syringe; placement on the floor of the mouth prevented premature spillage into the pharynx. Patients were then instructed to swallow. If the patient was unable to swallow or experienced dyspnoea, coughing or wet-hoarse dysphonia after swallowing, a score was recorded (1 for inability to swallow, 2 for dyspnoea and 3 for cough or dysphonia), and the test was terminated. Otherwise, the patient was asked to perform two dry (saliva) swallows. If the patient was able to swallow the water but unable to perform either of the two dry swallows, a score of 4 was recorded. If the patient was able to complete the water and both dry swallows, a score of 5 was recorded. The entire procedure was repeated twice, and the final score was defined as the lowest score on any trial [8].