ULTRASONIC EVALUATION OF MOVEMENT OF THE DIAPHRAGM AFTER ACUTE CEREBRAL INFARCTION

Respiratory dysfunction is an important complication of acute stroke b ut its mechanisms are poorly understood. Previous indirect assessments suggest that paralysis of the diaphragm occurs contralateral to the c erebral lesion. Diaphragmatic excursion was studied with real time ult rasound during quiet and deep breathing in 50 patients within 72 hours of acute stroke and 40 controls. During quiet breathing, hemidiaphrag matic movements were not significantly different between right hemisph eric stroke, left hemispheric stroke, and controls. During deep inspir ation, there was a significant bilateral reduction in hemidiaphragmati c excursion in patients with stroke, for both right hemispheric stroke and left hemispheric stroke when compared with controls (both P < 0.0 01). Thus isolated hemidiaphragmatic paresis does not occur but maxima l excursion of the diaphragm is reduced bilaterally in patients with a cute stroke. This is a Likely contributor to the respiratory dysfuncti on after acute stroke.