Tracheotomised patient with brainstem stroke dysphagia

Data courtesy of Landesklinikum Baden-Mödling, Austria

Introduction

Dysphagia is a challenging consequence of brainstem stroke. In contrast to patients who present with hemispheric stroke, the dysphagia following brainstem stroke is generally more severe and may require enteral feeding for a longer period of time.

Case Report

A 77-year-old male presenting with brainstem stroke required a tracheotomy and intubation to support his breathing. Following this, he developed an impairment in swallow function and the clinical recommendation was no oral intake and placement of a Percutaneous Endoscopic Gastrostomy (PEG) tube to deliver nutrition.

Thereafter, in the 12 months after the stroke, the patient had a total of three chest infections. He was admitted to Intensive Care Unit with pneumonia and required resuscitation, followed by chest surgery to remove fibrotic lung tissue.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and bedside assessment at baseline showed a PAS=6 (pasty), PAS=7 (liquid) and a FOIS=1.

Treatment

At this point, approximately 12 months after the original stroke event, the patient received local dysphagia management standard of care, and in addition, Pharyngeal Electrical Stimulation (PES) treatment using the Phagenyx® system.  The treatment consisted of 10 minutes of patient optimised electrical stimulation once per day for 3 consecutive days.

Dysphagia patient case study   Dysphagia patient case study

Results

A FEES evaluation was performed directly after the last treatment and showed the scores had improved as follows PAS=3 (pasty), PAS=4 (liquid) and a FOIS=1.

In addition, the patient didn’t experience any further episodes of chest infection. Importantly, as the patient also met the criteria for decannulation, it was possible to remove his tracheotomy tube.

Conclusion

Dysphagia following brainstem stroke can be severe and persistent, leading to recurrent complications such as pneumonia over time. Even 12 months after the initial stroke event Phagenyx® treatment has been shown to provide significant improvement in swallow function and facilitate removal of a tracheotomy tube.

PAS=Penetration-Aspiration Scale; FOIS=Functional Oral Intake Scale; NIHSS=National Institutes of Health Stroke Scale; DSRS=Dysphagia Severity Rating Scale; NG tube=nasogastric tube

Phagenyx® system is CE marked and is available for sale only in the European Economic Area and Switzerland. The statements by Phagenesis’ customers described herein are based on results that were achieved in the customer’s unique setting. There cannot be any guarantee that other customers will achieve the same results.