In patients with lateral medullary infarction, a combined predictive model, the LARyNGTH score, can predict central neurogenic respiratory failure and facilitate preemptive intervention.
Central neurogenic respiratory failure (CNRF) occurred in a small proportion of patients with lateral medullary infarction (LMI).
Hypertension and diabetes mellitus were more common in patients with CNRF than in those without.
Patients with CNRF had higher stroke severity and worse swallowing function at baseline.
Imaging features of larger rostral infarcts and combined extramedullary lesions were more frequent in the CNRF group.
Multivariable analysis yielded the LARyNGTH score, and a cutoff above 5.5 predicted CNRF with high discrimination.
This study looked at patients who had a stroke in the lateral part of the medulla, a region of the brainstem involved in controlling breathing. Among 214 such patients treated at one university hospital between 2010 and 2022, 12 (about 5.6%) developed central neurogenic respiratory failure, a dangerous complication in which the brain fails to drive breathing properly, leading to emergency intubation or resuscitation. Patients who developed this complication were more likely to have high blood pressure and diabetes, had more severe strokes on a standard neurological scale, and did worse on a swallowing screening test. Their brain scans more often showed large infarcts extending toward the upper part of the medulla and additional lesions outside the medulla. The researchers combined these factors into a scoring tool called the LARyNGTH score. A score above 5.5 identified the patients who developed respiratory failure with about 92% sensitivity and 95% specificity. This research suggests that a simple combination of clinical and imaging findings could help doctors flag which patients with this type of stroke are at highest risk of breathing failure, allowing closer monitoring or earlier intervention. However, the study was done at a single hospital and only 12 patients had the complication, so the score would need to be tested in other groups of patients before its usefulness can be confirmed.
Kim Y, Park S, Park J, Park B, Lee J, Lee S. (2026). Development of the LARyNGTH score to predict central neurogenic respiratory failure in lateral medullary infarction.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1864132