Clinical and Radiological Characteristics Associated with Respiratory Failure in Unilateral Lateral Medullary Infarction |
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| Authors: | Katja Pavšič Andrej Fabjan Vid Zgonc Katarina Šurlan Popović Janja Pretnar Oblak Fajko F Bajrović |
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| Institution: | 1. Department of Vascular Neurology and Intensive Therapy, University Medical Centre Ljubljana, Slovenia;2. Faculty of Medicine, University of Ljubljana, Slovenia;3. Institute of Physiology, Faculty of Medicine, University of Ljubljana, Slovenia;4. Clinical Institute of Radiology, University Medical Centre Ljubljana, Slovenia;5. Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Slovenia;1. Department of Cardiology, Bagcilar Training and Research Hospital, Istanbul, Turkey;2. Department of Cardiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey;3. Department of Cardiology, Istanbul University – Cerrahpasa, Institute of Cardiology, Istanbul,Turkey;4. Department of Cardiology, Adiyaman University Training and Research Hospital, Adiyaman, Turkey;5. Department of Neurology, Bagcilar Training and Research Hospital, Istanbul, Turkey;1. Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu Japan;2. Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan;1. Neurosciences Intensive Care Unit, Department of Neurology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA;2. Department of Neurological surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA;3. Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA;4. Division of Neurocritical Care, Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;1. State Key Laboratory of Natural Medicines, Department of Physiology, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China;2. Mongolian University of Pharmaceutical Sciences, Ulaanbaatar 18130, Mongolia;1. Department of Neurology, People''s Hospital of Deyang City, Deyang, China;2. Department of Neurology, the Affiliated Longyan first Hospital of Fujian Medical University, Longyan, China;3. Department of Neurology, the Second People''s Hospital of Deyang City, Deyang, China;4. Department of Neurology, the Second Affiliated Hospital and Yuying Children''s Hospital of Wenzhou Medical University, Wenzhou, China;5. Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University, Zhejiang, China |
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| Abstract: | BackgroundThe 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 MethodsSeventy-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.ResultsRespiratory 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.ConclusionsExtensive 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. |
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