Volume 3, Issue 1, March 2019, Page: 16-23
Profile of Swallowing Disorders in Acute Stroke in Brazzaville
Ghislain Armel Mpandzou, Department of Neurology, University Hospital of Brazzaville, Brazzaville, Republic of Congo; Marien NGOUABI University of Brazzaville, Faculty of Health Sciences, Brazzaville, Republic of Congo
Paul Macaire Ossou-Nguiet, Department of Neurology, University Hospital of Brazzaville, Brazzaville, Republic of Congo; Marien NGOUABI University of Brazzaville, Faculty of Health Sciences, Brazzaville, Republic of Congo
Lopresty Luberde Ngouala, Department of Neurology, University Hospital of Brazzaville, Brazzaville, Republic of Congo
Annette Oball-Mond Mwankie, Marien NGOUABI University of Brazzaville, Faculty of Health Sciences, Brazzaville, Republic of Congo; Stomatology and Maxillofacial Surgery Department, University Hospital of Brazzaville, Brazzaville, Republic of Congo
Prince Eliot Sounga Bandzouzi, Marien NGOUABI University of Brazzaville, Faculty of Health Sciences, Brazzaville, Republic of Congo; Neurology Department, Loandjili General Hospital, Pointe Noire, Republic of Congo
Dinah Happhia Motoula Latou, Department of Neurology, University Hospital of Brazzaville, Brazzaville, Republic of Congo; Marien NGOUABI University of Brazzaville, Faculty of Health Sciences, Brazzaville, Republic of Congo
Bébène Bandzouzi Ndamba, Department of Neurology, University Hospital of Brazzaville, Brazzaville, Republic of Congo; Marien NGOUABI University of Brazzaville, Faculty of Health Sciences, Brazzaville, Republic of Congo
Received: Mar. 14, 2019;       Accepted: May 8, 2019;       Published: May 30, 2019
DOI: 10.11648/j.cnn.20190301.14      View  24      Downloads  4
Swallowing disorders are common in stroke and cause significant morbidity and mortality. The aim of this study was to determinate the frequency of swallowing disorders and its impact on the prognosis of stroke, as well as the contribution of the local feeding protocol at University Hospital of Brazzaville. An interventional study was carried out between March and August 2016 in the department of neurology, with a follow-up of three months. It included all patients hospitalized for stroke and swallowing disorders. If necessary, a nasogastric tube was placed and local feeding protocol was initiated. Among 219 patients admitted for stroke, 59 (26.9%) had swallowing disorders. The DePippo test was positive in 54 (91.5%) patients. The mean age of the patients was 69.1 ± 13.8 years with a sex ratio of 1.3. Cough during feeding (79.7%) and swallowing effort (81.4%) were the most common complaints. The majority (72.9%) of patients had bilateral pyramidal involvement, and 23 (39%) a history of stroke. The local feeding protocol was respected by only half of patients, without any impact on the occurrence of malnutrition and dehydration (respectively, p=0.58 and p=0.79). Death was observed in 32 (54.24%) patients primarily for bronchopneumopathy (n=5, 15.62%), false roads (n=4, 12.5%) and cerebral hematoma (n=4, 12.50%). Eleven (34.4%) patients died at home for an undetermined cause. Detection and appropriate management of swallowing disorders in acute stroke, must be systematic and included in management protocols of stroke.
Stroke, Swallowing Disorders, Feeding Protocol
To cite this article
Ghislain Armel Mpandzou, Paul Macaire Ossou-Nguiet, Lopresty Luberde Ngouala, Annette Oball-Mond Mwankie, Prince Eliot Sounga Bandzouzi, Dinah Happhia Motoula Latou, Bébène Bandzouzi Ndamba, Profile of Swallowing Disorders in Acute Stroke in Brazzaville, Clinical Neurology and Neuroscience. Vol. 3, No. 1, 2019, pp. 16-23. doi: 10.11648/j.cnn.20190301.14
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Bourazza A, Kerouache A, Reda R, Mounach J, Mosseddaq R. [Meningovascular syphilis: Study of five cases]. Rev. Neurol. (Paris) 2008;164(4):369-73.
Adeloye D. An estimate of the incidence and prevalence of stroke in Africa: a systematic review and meta-analysis. PLoS One2014;9(6):e100724. doi: 10.1371/journal.pone.0100724.
Adoukonou TA, Vallat JM, Joubert J, Macian F, Kabore R, Magy L, et al. [Management of stroke in sub-Saharan Africa: Current issues]. Rev. Neurol. (Paris) 2010;166(11):882-93.
Gombet T, Ossou-Nguiet PM, Ampion MO, Ellenga-Mbolla BF, Bandzouzi-Ndamba B, Matali E, et al. Facteurs de mortalité des accidents vasculaires cérébraux au CHU de Brazzaville. Rev. Neurol. (Paris) 2012;168:A87-A8.
Mann G, Hankey GJ. Initial clinical and demographic predictors of swallowing impairment following acute stroke. Dysphagia. 2001;16(3):208-15.
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.
Lakshminarayan K, Tsai AW, Tong X, Vazquez G, Peacock JM, George MG, et al. Utility of dysphagia screening results in predicting poststroke pneumonia. Stroke. 2010;41(12):2849-54.
Singh S, Hamdy S. Dysphagia in stroke patients. Postgrad. Med. J. 2006;82(968):383-91.
Walter U, Knoblich R, Steinhagen V, Donat M, Benecke R, Kloth A. Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit. J. Neurol. 2007;254(10):1323.
Steinhagen V, Grossmann A, Benecke R, Walter U. Swallowing disturbance pattern relates to brain lesion location in acute stroke patients. Stroke. 2009;40(5):1903-6.
Ossou-Nguiet P, Ellenga-Mbolla B, Odzebe A, Otiobanda G, Gankama T, Obondzo-Aloba K, et al. Impact of urinary tract and pulmonary infection on mortality after intracerebral hemorrhage in Brazzaville. World J. Neurosci. 2013;3(04):246.
Hilker R, Poetter C, Findeisen N, Sobesky J, Jacobs A, Neveling M, et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care Medicine. Stroke 2003;34(4):975-81.
Falsetti P, Acciai C, Palilla R, Bosi M, Carpinteri F, Zingarelli A, et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J. Stroke Cerebrovasc. Dis. 2009;18(5):329-35.
Runions S, Rodrigue N, White C. Practice on an acute stroke unit after implementation of a decision-making algorithm for dietary management of dysphagia. J. Neurosci. Nurs. 2004;36(4):200.
Capet C, Delaunay O, Idrissi F, Landrin I, Kadri N. [Swallowing disorders in the elderly: recognizing risk factors for early management]. NPG Neurologie - Psychiatrie–Gériatrie2007;7(40):15-23.
Carnaby-Mann G, Lenius K, Crary M. Update on assessment and management of dysphagia post stroke. Northeast Florida Med. 2007;58(2):31-4.
Badve MS, Zhou Z, Anderson CS, Hackett ML. Effectiveness and safety of antibiotics for preventing pneumonia and improving outcome after acute stroke: systematic review and meta-analysis. J. Stroke Cerebrovasc. Dis. 2018 Aug6. pii:SS1052-3057(18)30368-9.
Morrell K, Hyers M, Stuchiner T, Lucas L, Schwartz K, Mako J, et al. Telehealth stroke dysphagia evaluation is safe and effective. Cerebrovasc. Dis. 2017;44(3-4):225-31.
Nordio S, Innocenti T, Agostini M, Meneghello F, Battel I. The efficacy of telerehabilitation in dysphagic patients: a systematic review. ActaOtorhinolaryngol. Ita. 2018;38(2):79-85.
Huang YC, Hsu TW, Leong CP, Hsieh HC, Lin WC. Clinical effects and differences in neural function connectivity revealed by MRI in subacute hemispheric and brainstem infarction patients with dysphagia after swallowing therapy. Front. Neurosci. 2018;12:488.
DePippo KL, Holas MA, Reding MJ. Validation of the 3-oz water swallow test for aspiration following stroke. Arch. Neurol. 1992;49(12):1259-61.
Paciaroni M, Mazzotta G, Corea F, Caso V, Venti M, Milia P, et al. Dysphagia following Stroke. Eur. Neurol. 2004;51(3):162-7.
Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. Jama. 1999;282(21):2019-26.
Audebert HJ, Rott MM, Eck T, Haberl RL. Systemic inflammatory response depends on initial stroke severity but is attenuated by successful thrombolysis. Stroke. 2004;35(9):2128-33.
BaroniAF, Fàbio SR, Dantas RO. Risk factors for swallowing dysfunction in stroke patients. Arg. Gastroenterol. 2012;49(2):118-24.
Mackay LE, Morgan AS, Bernstein BA. Swallowing disorders in severe brain injury: Risk factors affecting return to oral intake. Arch. Phys. Med. Rehabil. 1999;80(4):365-71.
Langdon PC, Lee AH, Binns CW. Dysphagia in acute ischaemic stroke: severity, recovery and relationship to stroke subtype. J. Clin. Neurosci. 2007;14(7):630-4.
Arnold M, Liesirova K, Broeg-Morvay A, Meisterernst J, Schlager M, Mono M-L, et al. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome. PloS one. 2016;11(2):e0148424.
Crary MA, Carnaby GD, Sia I, Khanna A, Waters MF. Spontaneous Swallowing Frequency Has Potential to Identify Dysphagia in Acute Stroke. Stroke. 2013;44(12):3452-7.
SørensenRT, Rasmussen RS, Overgaard K, Lerche A, Johansen AM, Lindhardt T. Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke. J. Neurosci. Nurs. 2013;45(3):139-46.
Kidd D, Lawson J, Nesbitt R, MacMahon J. The natural history and clinical consequences of aspiration in acute stroke. QJM 1995;88(6):409-13.
Ickenstein GW, Hohlig C, Prosiegel M, Koch H, Dziewas R, Bodechtel U, et al. Prediction of outcome in neurogenic oropharyngeal dysphagia within 72 hours of acute stroke. J. Stroke Cerebrovasc. Dis. 2012;21(7):569-76.
de AlencarNunes MC, Jurkiewicz AL, Santos RS, Furkim AM, Massi G, Pinto GSA, et al. Correlation between brain injury and dysphagia in adult patients with stroke. Int. Arch. Otorhinolaryngol. 2012;16(03):313-21.
Al-Khaled M, Matthis C, Binder A, Mudter J, Schattschneider J, Pulkowski U, et al. Dysphagia in patients with acute stroke: early dysphagia screening may reduce stroke-related pneumonia and improve stroke outcome. Cerebrovasc. Dis. 2016;42(1-2):81-9.
Desport J-C, Fayemendy P, Jésus P, Salle J-Y. [Management of swallowing disorders]. Nutr. Clin. Metab. 2014;28(3):221-4.
Pouderoux P. Troubles de la déglutition: étiologies et prise en charge. Hépato-Gastro & Oncologie Digestive. 1999;6(4):247-57.
Huang K-L, Liu T-Y, Huang Y-C, Leong C-P, Lin W-C, Pong Y-P. Functional Outcome in Acute Stroke Patients with Oropharyngeal Dysphagia after Swallowing Therapy. J. Stroke Cerebrovasc. Dis. 2014;23(10):2547-53.
Ossou-Nguiet PM, Gombet TR, OssilAmpion M, Otiobanda GF, Obondzo-Aloba K, Bandzouzi-Ndamba B. [Gender and stroke in Brazzaville]. Rev. Epidémiol. Sante2014;62(1):78-82.
Ikama MS, Nsitou BM, Makani J, Nkalla-Lambi M, Passi-Louamba C. [Hypertension and rate control in Brazzaville (Congo): Place of ambulatory blood pressure monitoring (ABPM)]. Annal. Cardiol. Angéiol. 2015;64(2):76-80.
Medeiros GCd, Sassi FC, Mangilli LD, Zilberstein B, Andrade CRFd. Clinical dysphagia risk predictors after prolonged orotracheal intubation. Clinics. 2014;69:8-14.
Gombet TR, Ossou-Nguiet PM, Gankama TN, Ellenga-Mbolla BF, Otiobanda GF, Obondzo-Aloba K, et al. Hypertension and intracerebral hemorrhage in Brazzaville. World J. Cardiovasc. Dis. 2013;3(09):523.
Lemogoum D, Degaute J-P, Bovet P. Stroke Prevention, Treatment, and Rehabilitation in Sub-Saharan Africa. Am. J. Prev. Med. 2005;29(5):95-101.
Gassaye D, Bossali F, Atipo-Ibara B, Ahoui CR, Mouele MD, Ibara JR. Prévalence de la consommation d’alcool dans la ville de Brazzaville en 2014. Journal Africain d'Hépato-Gastroentérologie 2015;9(4):160-2.
Kimbally K, G, Voumbo Y, Gombet T, Ikama M, S , Bolanda J, Gokaba C, et al. Etude de la prévalence de la consommation de l’alcool et du tabac à Brazzaville. Cardiologie Tropicale 2008;129(33).
Salle J-Y, Lissandre J-P, Morizio A, Bouthier-Quintard F, Desport J-C. Dépistage et prise en charge des troubles de la déglutition chez les personnes âgées. In : Traité de nutrition de la personne âgée. Springer (Paris) 2009. p. 221-7.
Kim IS, Han TR. Influence of Mastication and Salivation on Swallowing in Stroke Patients. Arch. Phys. Med. Rehabil. 2005;86(10):1986-90.
Saito T, Hayashi K, Nakazawa H, Ota T. Clinical characteristics and lesions responsible for swallowing hesitation after acute cerebral infarction. Dysphagia 2016;31(4):567-73.
Hamdy S, Aziz Q, Rothwell JC, Crone R, Hughes D, Tallis RC, et al. Explaining oropharyngeal dysphagia after unilateral hemispheric stroke. Lancet (London) 1997;350(9079):686-92.
Teismann IK, Dziewas R, Steinstraeter O, Pantev C. Time-dependent hemispheric shift of the cortical control of volitional swallowing. Hum. Brain Mapp. 2009;30(1):92-100.
Moon HI, Yoon SY, Jeong YJ, Cho TH. Lesions responsible for delayed oral transit time in post-stroke dysphagia. Dysphagia 2018;33(3):321-8.
Daniels SK, Brailey K, Foundas AL. Lingual discoordination and dysphagia following acute stroke: analyses of lesion localization. Dysphagia. 1999;14(2):85-92.
Kwon M, Lee JH, Kim JS. Dysphagia in unilateral medullary infarction: lateral vs medial lesions. Neurology 2005;65(5):714-8.
Flamand-Roze C, Roze E, Denier C. [Language and swallowing disorders in acute stroke patients: Tools and early management]. Rev. Neurol. (Paris) 2012;168(5):415-24.
Barritt AW, Smithard DG. Role of cerebral cortex plasticity in the recovery of swallowing function following dysphagic stroke. Dysphagia 2009;24(1):83-90.
Hamdy S, Aziz Q, Rothwell JC, Power M, Singh KD, Nicholson DA, et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology. 1998;115(5):1104-12.
Teismann IK, Suntrup S, Warnecke T, Steinstrater O, Fischer M, Floel A, et al. Cortical swallowing processing in early subacute stroke. BMC Neurology 2011;11:34.
Smithard DG, O'Neill PA, Parks C, Morris J. Complications and outcome after acute stroke. Does dysphagia matter? Stroke 1996;27(7):1200-4.
González-Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after stroke: an overview. Curr. Phys. Med. Rehabil. Rep. 201;1(3) :187-96.
Le Fort M, Hamon P, Mathé J-F, Perrouin-Verbe B. Typologie analytique et fonctionnelle de troubles de la déglutition selon l’étiologie neurologique ou neuromusculaire de 153 patients adressés à la consultation spécialisée du CHU de Nantes. Ann. Phys. Rehabil. Med. 2011;54:e31.
Altman KW, Yu GP, Schaefer SD. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Arch. Otolaryngol. Head Neck Surg. 2010;136(8):784-9.
Foley NC, Martin RE, Salter KL, Teasell RW. A review of the relationship between dysphagia and malnutrition following stroke. J Rehabil Med. 2009;41(9):707-13.
Collaboration FT. Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke. 2003;34(6):1450-6.
Hamidon BB, Abdullah SA, Zawawi MF, Sukumar N, Aminuddin A, Raymond AA. A prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with acute dysphagic stroke. Med. J. Malaysia 2006;61(1):59-66.
Lim K-B, Lee H-J, Lim S-S, Choi Y-I. Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: A randomized controlled trial. J. Rehabil. Med. 2009;41(3):174-8.
Browse journals by subject