Characteristics of Patients With Aneurysmal Subarachnoid Hemorrhage and Risk Factors Related to Dysphagia

Abstract

ObjectiveTo investigate the characteristics and risk factors of dysphagia with the Videofluoroscopic Dysphagia Scale (VDS) using a videofluoroscopic swallowing study (VFSS) in patients with ruptured aneurysmal subarachnoid hemorrhage (aSAH).MethodsData of 64 patients presenting with first-ever ruptured aSAH were analyzed. Characteristics of dysphagia were evaluated using VFSS and all subjects were divided into a high (>47) and low risk group (≤47) by the VDS score. Clinical and functional parameters were assessed by medical records including demographics, hypertension and diabetes mellitus (DM), the Glasgow Coma Scale (GCS), the Hunt and Hess scale, endotracheal intubation, acute management modalities, as well as Korean version of the Mini-Mental Status Examination (K-MMSE) and Korean version of Modified Barthel Index (K-MBI). Radiologic factors identified the amount of hemorrhage, ventricular rupture, and aneurysmal location.ResultsAbout a half of the subjects showed oral phase abnormalities and the oral transit time was delayed in 46.8% of the patients. The pharyngeal transit time was also prolonged in 39.0% of the subjects and the proportion of penetration and aspiration observed was 46.8%. The parameters-GCS score (p=0.048), hemorrhagic volume (p=0.028), presence of intraventricular hemorrhage (p=0.038), and K-MMSE (p=0.007)-were predisposing factors for dysphagia in patients with aSAH.ConclusionAbnormalities in the oral phase were more prominent in patients with aSAH than in those with other types of stroke. The risk factors associated with dysphagia persisting over 6 months after stroke onset were the initial GCS, hemorrhage volume, presence of intraventricular hemorrhage, and cognitive status as measured by the K-MMSE.

Risk Factors for Dysphagia and the Impact on Outcome After Spontaneous Subarachnoid Hemorrhage

“…The main findings were that (1) dysphagia was diagnosed in every third SAH patient, including patients admitted in good clinical grade, that (2) dysphagia was associated with radiographic and clinical disease severity on admission, and (3) that dysphagia was strongly associated with hospital complications, prolonged ICU stay, and poor functional outcome. Although it is well known that the high incidence of swallowing disorders after ischemic stroke contributes to impaired quality of life and poor functional outcome, only few studies report the incidence of dysphagia following SAH [9,10]. In a retrospective cohort study including predominantly good-grade SAH patients, the incidence was 31.6%, which is comparable to our findings [9].…”

“…Known risk factors for the development of dysphagia after SAH include older age, initial disease severity, the amount of cisternal and intraventricular blood, detection of an aneurysm, rebleeding, hydrocephalus, vasospasm, cerebral ischemia, and mechanical ventilation [9,10]. We additionally identified parenchymal hematoma as being independently associated with the development of dysphagia.…”

“…So far, the incidence of dysphagia in SAH patients has been reported to range between 31.6 and 46.8% [9,10]. Several risk factors for the development of dysphagia were identified; however, the impact of impaired swallowing on functional outcome remains poorly described.…”

Risk factors for dysphagia after a spinal cord injury: a systematic review and meta-analysis

“…The risk factors identified for the SCI population are different than those in other neurological populations. For example, among individuals with stroke, the development of dysphagia has been correlated with Glasgow Coma Scale score, hemorrhagic volume, presence of intraventricular hemorrhage, and Mini Mental State Examination score [31], as well as National Institutes of Health Stroke Scale score, pontine infarction, and white matter hyperintensities [32]. Our findings may also assist with appropriate treatment planning for the medical management of tetraplegia, specifically regarding interventions which contribute to the risk of developing dysphagia [33,34].…”

Dysphagia following non‐traumatic subarachnoid haemorrhage: A prospective pilot study

“…2010, Rhie et al . 2016, Yap and Chua 2002). The wide variance in incidence and characteristics likely reflects the significant variation in study populations, methodology, timing to assessment and dysphagia identification practices (Dunn et al .…”