This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (66)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Takuma Nakagawa, MD; Kiyohisa ekizawa,, MD; Hiroyuki Arai, MD; Ryo Kikuchi, MD; Katsuhiro Manabe, MD; Hidetada Sasaki, MD

Arch Intern Med. 1997;157(3):321-324.

Abstract
Background
Pneumonia is a major cause of death in patients with cerebral infarction. We assessed morbidity associated with pneumonia in 276 patients 65 years of age or older who were admitted to a long-term care facility. Furthermore, we studied the swallowing reflex during the day and at night and monitored the occurrence of silent aspiration during sleep.

Objectives
To examine the possible relationship between the location of cerebral hemispheric infarctions and the incidence of pneumonia and to evaluate the role of silent aspiration in the development of pneumonia.

Methods
The incidence of pneumonia was analyzed in 4 groups of patients who were assigned to a group on the basis of the following computed tomographic findings: no infarct (group A); 1 or more unilateral basal ganglia infarcts (group B); bilateral basal ganglia infarcts (group C); and 1 or more cerebral hemispheric infarcts outside the basal ganglia (group D). Criteria for diagnosis of pneumonia were (1) a new pulmonary infiltrate seen on a chest radiograph and (2) 1 or more of the following features: cough, temperature greater than 37.8°C, or subjective dyspnea. Before the study, the patients with stroke were followed up for more than 1 year after their ictus and were monitored to determine if they sustained affecting cerebral hemispheric structures. The average duration of observation for incidence of pneumonia was 22 months. To study the swallowing reflex and to monitor for the occurrence of silent aspiration during sleep, 15 of the patients who were confined to bed or chair were randomly selected from each of groups A through C. The swallowing reflex was examined at both 1 PM and 1 AM and was evaluated according to latency of response, which was timed from the injection of 1 mL of distilled water into the pharynx through a nasal catheter to the onset of swallowing. The incidence of silent aspiration during sleep was examined using indium-111 chloride as a radioactive tracer attached to the teeth, and scanning of the thorax was performed the next morning.

Results
The incidence of pneumonia was 2.12 times higher in the patients of group B (27.4%; P<.01) and 3.64 times higher in the patients of group C (47.0%; P<.001) than in the patients of group A (12.9%). The latency of response was longer in the patients of groups B (P<.05) and C (P<.001) than in those of group A at 1 AM. The percentage of positive scans was also higher in the patients of groups B (P<.01 ) and C (P<.001 ) than in those of group A.

Conclusion
Basal ganglia strokes might predispose these patients to develop pneumonia owing to frequent aspiration during sleep.

Arch Intern Med. 1997;157:321-324

Author Affiliations
From the Department of Geriatric Medicine, Tohoku University School of Medicine, Sendai, Japan.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Effects of Prophylactic Antibiotic Therapy With Mezlocillin Plus Sulbactam on the Incidence and Height of Fever After Severe Acute Ischemic Stroke: The Mannheim Infection in Stroke Study (MISS)
Schwarz et al.
Stroke 2008;39:1220-1227.
ABSTRACT | FULL TEXT  

Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
Adams et al.
Circulation 2007;115:e478-e534.
ABSTRACT | FULL TEXT  

Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists
Adams et al.
Stroke 2007;38:1655-1711.
ABSTRACT | FULL TEXT  

From the authors
van de Garde
Eur Respir J 2007;29:219-220.
FULL TEXT  

Statin treatment and reduced risk of pneumonia in patients with diabetes
van de Garde et al.
Thorax 2006;61:957-961.
ABSTRACT | FULL TEXT  

Association of susceptibility to the development of pneumonia in the older Japanese population with haem oxygenase-1 gene promoter polymorphism.
Yasuda et al.
J. Med. Genet. 2006;43:e17-e17.
ABSTRACT | FULL TEXT  

The Early Systemic Prophylaxis of Infection After Stroke Study: A Randomized Clinical Trial
Chamorro et al.
Stroke 2005;36:1495-1500.
ABSTRACT | FULL TEXT  

ACE inhibitors and protection against pneumonia in elderly patients with stroke
Arai et al.
Neurology 2005;64:573-574.
FULL TEXT  

Prognostic Implications of Swallowing Ability in Elderly Patients After Initial Recovery From Stroke
Iwamoto et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2005;60:120-124.
ABSTRACT | FULL TEXT  

Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association
Adams et al.
Stroke 2003;34:1056-1083.
FULL TEXT  

Aspiration Pneumonia: Incidence, Mortality, and At-Risk Populations
DeLegge
JPEN J Parenter Enteral Nutr 2002;26:S19-S25.
ABSTRACT  

Future Considerations in Aspiration Pneumonia in the Critically Ill Patient: What Is Not Known, Areas for Future Research, and Experimental Methods
DiSario
JPEN J Parenter Enteral Nutr 2002;26:S75-S79.
ABSTRACT  

Acid Stimulation Reduces Bactericidal Activity of Surface Liquid in Cultured Human Airway Epithelial Cells
Nakayama et al.
Am. J. Respir. Cell Mol. Bio. 2002;26:105-113.
ABSTRACT | FULL TEXT  

The Characterization of Bronchoalveolar Lavage Fluid in Very Elderly Patients With Cerebrovascular Disease
Kikawada et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2001;56:M771-774.
ABSTRACT | FULL TEXT  

Satisfaction of Patients Treated Surgically for Intractable Aspiration
Takano et al.
Chest 1999;116:1251-1256.
ABSTRACT | FULL TEXT  

Investigation of Effects of Anesthesia and Age on Aspiration in Mice through LacZ Gene Transfer by Recombinant E1-deleted Adenovirus Vectors
TERAMOTO et al.
Am. J. Respir. Crit. Care Med. 1998;158:1914-1919.
ABSTRACT | FULL TEXT  

Dopamine D1 receptor antagonist inhibits swallowing reflex in guinea pigs
Jia et al.
Am. J. Physiol. Regul. Integr. Comp. Physiol. 1998;274:R76-R80.
ABSTRACT | FULL TEXT