Association between stroke lesions and videofluoroscopic findings in acute stroke patients

Abstract

Background and purpose We aimed to assess stroke lesions, which play a key role in determining swallowing dysfunction, and findings of videofluoroscopy (VF), which provides the most accurate instrumental assessment for evaluating swallowing function, in patients with acute stroke. Methods We enrolled 342 patients with first-time acute stroke (age 70.4 ± 12.6 years, 142 female). Patients with dementia and altered mental status due to severe stroke were excluded. All patients underwent cranial magnetic resonance imaging to identify the location of stroke lesion, VF, and tongue pressure measurement. Results Aspiration was detected in 45 (13.2%) patients. Multivariate analysis identified parietal lobe lesion and the National Institutes of Health Stroke Scale (NIHSS) score as independent significant factors for aspiration (odds ratio 6.33, 95% confidence interval [CI] 2.25-17.84, p < 0.001; odds ratio 1.12, 95% CI 1.03-1.20, p = 0.004, respectively). Swallowing reflex delay was detected in 58 (17.0%) patients. Multivariate analysis identified habitual drinking, basal ganglia lesion, and the NIHSS score as independent significant factors for swallowing reflex delay (odds ratio 0.51, 95% CI 0.26-0.99, p = 0.047; odds ratio 1.91, 95% CI 1.09-3.67, p = 0.041; odds ratio 1.12, 95% CI 1.05-1.20, p < 0.001, respectively). Additionally, oral cavity and pharyngeal residues were independently associated with tongue pressure. Conclusion Parietal lobe lesions are associated with aspiration and basal ganglia lesions with swallowing reflex delay.

Swallow Safety and Laryngeal Kinematics: A Comparison of Dysphagia Between Parkinson’s Disease and Cerebrovascular Accident

“…While we originally hypothesized PWPD would have higher rates of penetration or aspiration, this was not the case. Patients in the CVA group presented with findings of aspiration 10% of the time and abnormal rates of swallow safety in 30% of swallows, in line with previous literature exploring swallow safety outcomes in post-CVA patients [36,37]. PWPD displayed similar outcomes, with 8% categorized as silent aspiration alone and 33% of swallows categorized as abnormal PAS scores overall.…”

Effects of Insular Cortex on Post-Stroke Dysphagia: A Systematic Review and Meta Analysis

“…The median sample size was 95 (ranging from 20 to 342). Thirteen of the included studies were supratentorial strokes [ 11 , 12 , 13 , 17 , 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ], one infratentorial stroke [ 36 ], and seven both the supratentorial and infratentorial strokes [ 16 , 37 , 38 , 39 , 40 , 41 , 42 ]. Besides, subjects of sixteen studies were in acute phase of stroke [ 11 , 12 , 13 , 14 , 16 , 17 , 25 , 29 , 34 , 35 , 38 , 39 , 41 , 42 , 43 , 44 ], one was in subacute phase of stroke [ 30 ], and one was in chronic phase of stroke [ 28 ], while the stroke phases of the remaining six studies were unclear ( Table 1 ).…”

“…As shown in Table 2 , five of the included articles were prospective studies [ 25 , 34 , 38 , 41 , 42 ], five articles were retrospective ones [ 13 , 24 , 30 , 39 , 40 ], while the types of other fourteen articles were unclear. A total of fourteen articles reported being assessor-blinded [ 11 , 12 , 13 , 17 , 28 , 29 , 30 , 34 , 38 , 40 , 41 , 42 , 43 , 44 ], and the other ten were unclear. Twenty-three articles reported consistent assessment for all patients, and the remaining one was unclear [ 25 ].…”

Impact of Hemorrhagic Stroke on Molar Bite Force: A Prospective Study

“…One of the biggest problems for stroke patients is the difficulty in feeding and swallowing (Nakamori et al, 2021), which can lead to changes in food choices, leading patients to malnutrition. This study proves that even a few years after the hemorrhagic stroke, the stomatognathic system, especially the maximum molar bite force, is still functionally compromised, which is an important clinical report for the knowledge of physicians, nutritionists and speech therapists who work with these patients, seeking an adequate power diet, providing a better nutritional status and quality of life for patients.…”