Vocal cord paresis on CTA - A novel tool for the diagnosis of lateral medullary syndrome.
CTA
Stroke
Wallenberg
Journal
Journal of the neurological sciences
ISSN: 1878-5883
Titre abrégé: J Neurol Sci
Pays: Netherlands
ID NLM: 0375403
Informations de publication
Date de publication:
15 10 2021
15 10 2021
Historique:
received:
18
03
2021
revised:
27
06
2021
accepted:
10
07
2021
pubmed:
30
8
2021
medline:
28
10
2021
entrez:
29
8
2021
Statut:
ppublish
Résumé
Diagnosis of lateral medullary syndrome (LMS) is often delayed due to elusive clinical presentations and frequently non-revealing neuroimaging tests. We aimed to investigate the use of ipsilateral vocal cord paresis (VCP) identified on neck computed tomography angiography (CTA) as an early diagnostic sign for LMS. Medical records were queried for patients admitted with LMS between 1/2012 and 10/2020. A control group of patients undergoing CTA for transient or no neurological symptoms was matched for sex and age. Clinical data were collected by a stroke neurologist. Two neuroradiologists independently and blindly assessed CTA images for radiological signs of VCP. Fifteen LMS and 15 control patients were included in the analysis. Median time from arrival to LMS diagnosis was 29.4 h [IQR 7,47] and twice as long in patients who suffered aspiration pneumonia. Thrombolysis rate was 0% in LMS patients versus 14.5% in general stroke patients. Dysphonia was noted in the emergency department in three (20%) patients, whereas all 15 patients had radiological signs of VCP on CTA. Medialization of a true vocal cord was the most sensitive (100%) and specific (80-87%) sign for LMS, with good inter-rater agreement (kappa 0.66). Timely detection of VCP on CTA could have shortened median time to LMS diagnosis by 14 h and enabled thrombolytic therapy in 3 (20%) patients. VCP on CTA is a valuable sign for the diagnosis of LMS. If detected early, it may enable reperfusion therapy and prevent aspiration pneumonia, consequently saving life and diminishing disability.
Sections du résumé
BACKGROUND
Diagnosis of lateral medullary syndrome (LMS) is often delayed due to elusive clinical presentations and frequently non-revealing neuroimaging tests. We aimed to investigate the use of ipsilateral vocal cord paresis (VCP) identified on neck computed tomography angiography (CTA) as an early diagnostic sign for LMS.
METHODS
Medical records were queried for patients admitted with LMS between 1/2012 and 10/2020. A control group of patients undergoing CTA for transient or no neurological symptoms was matched for sex and age. Clinical data were collected by a stroke neurologist. Two neuroradiologists independently and blindly assessed CTA images for radiological signs of VCP.
RESULTS
Fifteen LMS and 15 control patients were included in the analysis. Median time from arrival to LMS diagnosis was 29.4 h [IQR 7,47] and twice as long in patients who suffered aspiration pneumonia. Thrombolysis rate was 0% in LMS patients versus 14.5% in general stroke patients. Dysphonia was noted in the emergency department in three (20%) patients, whereas all 15 patients had radiological signs of VCP on CTA. Medialization of a true vocal cord was the most sensitive (100%) and specific (80-87%) sign for LMS, with good inter-rater agreement (kappa 0.66). Timely detection of VCP on CTA could have shortened median time to LMS diagnosis by 14 h and enabled thrombolytic therapy in 3 (20%) patients.
CONCLUSIONS
VCP on CTA is a valuable sign for the diagnosis of LMS. If detected early, it may enable reperfusion therapy and prevent aspiration pneumonia, consequently saving life and diminishing disability.
Identifiants
pubmed: 34455209
pii: S0022-510X(21)00270-7
doi: 10.1016/j.jns.2021.117576
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
117576Informations de copyright
Copyright © 2021. Published by Elsevier B.V.