Abstract
We compared clinical features of 4 patients with severe pseudobulbar palsy due to stroke. Case 1: A 65-year-old man with an ischemic stroke in the left middle cerebral artery (MCA) territory 10 years before admission was diagnosed as right MCA occlusion. Case 2: A 70-year-old woman with a lacunar infarction in the left corona radiata 2 years before admission was diagnosed as an acute lacunar infarction in the right corona radiata. Case 3: A 63-year-old man with a left putaminal hemorrhage 2 years back was admitted for a right putaminal hemorrhage. Case 4: An 83-year-old man was admitted for an ischemic stroke in the left anterior lobe. He was diagnosed as cardiogenic embolism, and another ischemic stroke was observed in the right frontal and occipital lobes 20 days after admission. Results: All 4 patients showed almost complete aphonia. Cases 1, 2, and 3 had total tongue paralysis, whereas case 4 was partially paralyzed. Pharyngeal reflex was absent and jaw-jerk reflex was inconsistent among them. Cases 1, 2, and 3 showed trismus, whereas case 4 did not. Videofluorography indicated severe oral and moderate pharyngeal disorder in cases 1, 2, and 3. Case 4 showed moderate oral and mild pharyngeal disorder. Cases 1, 2, and 3 did not improve in swallowing function. Case 4 resumed oral food intake after 5 months. No pneumonia occurred in these 4 patients. Conclusion: Trismus may be a predictor of poor outcome in swallowing function in patients with severe pseudobulbar palsy.
