Differences in Videofluoroscopic Swallowing Study (VFSS) Findings According to the Vascular Territory Involved in Stroke

Abstract

Dysphagia affects up to half of stroke patients and increases the risk of pneumonia and fatal outcomes. In order to assess swallowing difficulty, videofluoroscopic swallowing study (VFSS) has traditionally been the gold standard. The purpose of this study was to compare the patterns of post-stroke swallowing difficulties according to the vascular territories involved in the stroke. One hundred and three patients who were diagnosed with first ischemic stroke by brain magnetic resonance imaging and had swallowing difficulty were included in this study. Location of the stroke was classified into three groups: territorial anterior infarcts (TAI) (n = 62), territorial posterior infarcts (TPI) (n = 19) and white matter disease (WMD) (n = 22). Oral cavity residue existed significantly in the TAI group more than in any other groups (P = 0.017). The WMD group showed more residue in the valleculae (P = 0.002) and the TPI group showed more residue in the pyriform sinuses (P = 0.001). The oral transit time, pharyngeal delay time and pharyngeal transit time did not show significant differences among the groups with swallowing of both thick and thin liquids. Penetration and aspiration were more frequent in the TPI group (P < 0.05) with swallowing of both thick and thin liquids. The results suggest that TAI is more related to oral phase dysfunction and TPI is more related to pharyngeal dysfunction. In ischemic stroke, patterns of swallowing difficulty may differ according to the vascular territory involved and this should be considered in the management of post-stroke dysphagia.

Brain imaging correlates of recovered swallowing after dysphagic stroke: A fMRI and DWI study

“…Interestingly, Yamamoto et al (2014) have suggested that a left hemispheric stroke is associated with higher aspiration rates than a right hemispheric stroke, while territorial infarcts in posterior brain areas may result in more frequent penetration and aspiration with swallowing (Kim et al, 2014). Within the cortex, lesions of the insula (Daniels and Foundas, 1997, Daniels et al, 2006, Riecker et al, 2009), the frontal operculum (Meadows, 1973, Pender and Ferguson, 2007), and the primary sensorimotor cortex (Daniels et al, 1996) are most commonly associated with impairment of swallowing.…”

Tempo de trânsito oral e lateralidade da lesão cerebral no acidente vascular encefálico

“…The findings of a similar research on time variations done recently with a population of individuals who had suffered strokes were similar. Just like in this survey, the results have shown that there was variation in OTT in the different vascular areas involved in the lesion, without, however, any significant difference regarding cortical laterality (6) . On the other hand, in the study the individuals with leftside cortical lesion have shown TOTT above 2000 ms more often than individuals with right-side lesion.…”

“…For some authors, the representation of swallowing in the cortical region in healthy individuals, using brain mapping techniques, shows that the execution of the oral phase activates more the cortical region to the left, while the following stage, the pharyngeal phase, activates the cortical region to the right (4) . This research hypothesis has been strengthened by the current studies with magnetoencephalography and magnetic functional resonance (5,6) . Thus, while the relationship between swallowing and the brain cortex is investigated and the oral stage of swallowing appears represented by the left hemisphere (7,8) , studies of the oral stage of swallowing using temporal analysis methods advance slowly.…”

“…Besides that, the stroke population has been often studied in the surveys using temporal quantitative analysis, but these studies have concentrated on measuring the temporal values of each swallowing event and have rarely related this with other swallowing findings (11,12,13) . However, only a few studies have analyzed the relationship between the laterality of brain lesion and swallowing times in this population (6,14) . However, with the objective of understanding the relationships between the laterality of brain lesion and the findings found in swallowing measures times at their different stages, this study aimed to compare the total oral transit time (TOTT) with the laterality of the brain lesion in the stroke with oropharyngeal dysphagia.…”

Response to Letter Regarding Article, “Association of Leukoaraiosis With Convalescent Rehabilitation Outcome in Patients With Ischemic Stroke”

“…We agree that dysphagia can be affected by white matter involvement. 3 However, unfortunately, we did not assess the accurate estimation of the degree of dysphagia by using videofluoroscopic and video endoscopic examinations. Moreover, as well known, dysphagia is basically characterized by ischemic stroke lesions and their portions.…”