Dysphagia following Acute Thalamic Haemorrhage: Clinical Correlates and Outcomes

Abstract

Objective: A high incidence of dysphagia is seen during the acute phase of cerebral haemorrhage; however, there have been only rare reports of dysphagia caused by thalamic haemorrhage. We studied cases of thalamic haemorrhage during the acute period after hospitalization and examined the relationships between the frequency of dysphagia, stroke focus and haematoma volume. Methods: There were 113 subjects in this study, selected from 247 patients with thalamic haemorrhage who visited our rehabilitation centre. Patients were excluded if they had a history of dementia, stroke, confusion, epileptic seizure, surgical treatment or tracheotomy. We conducted a bedside swallowing assessment (BSA) by using the repetitive saliva swallowing test and modified water swallowing test. The relationships between oral intake condition at the time of hospital discharge, discharge destination (e.g. home), type of haematoma and haematoma volume were examined. Results: Abnormal BSA was found in 55% of the subjects (n = 62) with thalamic haemorrhage. Existence of a swallowing disorder was related to haematoma type and haematoma volume. A regular diet was possible in 41% of the subjects (n = 46). Age, haematoma volume, initial BSA evaluation and cognitive function had the greatest influence on a subject's ability to eat a general diet at the time of hospital discharge. Of those subjects in whom the initial BSA evaluation was normal, 70% were able to eat a regular diet at discharge. However, of those in whom the BSA evaluation was abnormal, >70% were discharged with enteral feeding. Furthermore, the rates of discharge to home were 95% in patients who could eat a regular diet and 30% in patients who needed enteral feeding. Conclusions: In the acute phase of thalamic haemorrhage, dysphagia was found in a high percentage of subjects. Dysphagia is associated with a poor prognosis for early hospital discharge.

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

“…These risk factors were similar to risk factors for dysphagia in patients with some degree of a stroke. Age [1718], black race [18], initial GCS score [18], ICH volume [1819] and Functional Independence Measure (FIM) scores on admission [17] were known to be independent predictors for long-term dysphagia in patients with hemorrhagic stroke. In comparison, the NIHSS score [2021], age [202122], left-sided lesion [23], history of diabetes [22], and baseline functional independence [21] were risk factors for dysphagia in ischemic stroke.…”

Dysphagia screening after intracerebral hemorrhage

“…In two studies, roughly one-quarter to one-third of patients with ICH were not screened. 4,10 Rates of dysphagia screen failure also differ among studies, from 43% in unselected ICH, 4 to 55% in thalamic hemorrhage 11 and 77% in striatocapsular hemorrhage. 12 Predictors of receiving or failing dysphagia screening after ICH have not been studied.…”

Dysphagia in neurological diseases: a literature review

“…Dysphagia is defined as an impairment of this complex and integrated sensorimotor system. Neurogenic dysphagia (ND) is typically occurring in patients with neurological disease of different etiologies (see Table 1), and it is associated to high mortality, morbidity, and social costs [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Neurological problems that cause dysphagia can be categorized in many different ways: anatomic location of the lesion (e.g., central nervous system, peripheral nervous system or muscle), pathogenetic mechanism of disease (e.g., ischemic injury or degenerative process), etiology, or clinic presentation (e.g., dementia or movement disorders).…”