Swallowing Disturbance Pattern Relates to Brain Lesion Location in Acute Stroke Patients

Steinhagen, Volker; Großmann, Annette; Benecke, Reiner; Walter, Uwe

doi:10.1161/strokeaha.108.535468

Cited by 114 publications

(81 citation statements)

References 16 publications

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“…Interestingly, the presence of BFA predicted DHA with a sensitivity of 87%. Our findings are supported by previous studies which describe an association between incoordination of labial, lingual and mandibular musculature during bolus transfer and BFA in patients with left-hemispheric damage [30,34,35]. According to our data, BFA and swallowing disorders can be determined as co-existent factors particularly in the acute phase of stroke.…”

Section: Discussionsupporting

confidence: 92%

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Dysphagia Risk Assessment in Acute Left-Hemispheric Middle Cerebral Artery Stroke

Somasundaram

Henke²,

Neumann‐Haefelin³

et al. 2014

Cerebrovasc Dis

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Background and Purpose: Bedside evaluation of dysphagia may be challenging in left middle cerebral artery (MCA) stroke due to frequently existing aphasia. Here we analyse the predictive value of common bedside screening tests and of two items of cortical dysfunction, aphasia and buccofacial apraxia (BFA), for the detection of dysphagia. Methods: We prospectively examined 67 consecutive patients with clinical and imaging evidence of acute (<72 h) left MCA stroke. Dysphonia, dysarthria, abnormal volitional cough and abnormal gag reflex were assessed followed by a standardized 50-ml water-swallowing test determining the symptoms cough and voice change after swallow. Aphasia and BFA were assessed according to defined criteria. Fibre-optic endoscopic evaluation of swallowing (FEES) was performed for validation of dysphagia. Results: 41 (61%) patients had FEES-proven dysphagia. Abnormal gag reflex, abnormal volitional cough, cough after swallow, aphasia and BFA were significantly more frequent in dysphagic as compared to non-dysphagic patients, while dysphonia, dysarthria and voice change after swallow were not. Aphasia and BFA had the highest sensitivity (97 and 78%, respectively) and high negative predictive values (89 and 68%, respectively) for dysphagia. Multivariate regression analysis did not identify an independent predictor of dysphagia. Conclusions: In left MCA stroke, the sensitivity and specificity of common bedside dysphagia screening methods are low. In contrast, aphasia and BFA have a high sensitivity and high negative predictive power, presumably due to the neuro-anatomical overlap between cortical regions involved in swallowing, speech production, imitation and voluntary movement control.

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Section: Discussionsupporting

confidence: 92%

“…If the patient did not respond to verbal commands, the SLP demonstrated the particular movements and asked for imitation. BFA was diagnosed if 2 or more tasks were performed incorrectly according to the following criteria: trial-and-error attempts, perseveration, substitution or inability of correct execution of the task [29,30]. …”

Section: Methodsmentioning

confidence: 99%

Dysphagia Risk Assessment in Acute Left-Hemispheric Middle Cerebral Artery Stroke

Somasundaram

Henke²,

Neumann‐Haefelin³

et al. 2014

Cerebrovasc Dis

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“…ischaemic cerebrovascular disease) [17,18]. Although this research includes a few cases of cerebral haemorrhage [5,19,20,21,22], few studies have focussed specifically on cerebral haemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia following Acute Thalamic Haemorrhage: Clinical Correlates and Outcomes

Maeshima

Osawa²,

Yamane³

et al. 2014

Eur Neurol

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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.

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“…So far, despite the absence of consensus on the best screening instrument, both the American (AHA) and German (DGN) guidelines [2,3] recommend a bedside swallow test using water or other consistencies [4,5,6]. These screening tools are easy to perform and provide a robust estimate of dysphagia risk.…”

Section: Introductionmentioning

confidence: 99%

Early Screening Parameters for Dysphagia in Acute Ischemic Stroke

2017

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Background: Dysphagia is a frequent symptom in patients with acute stroke. It is associated with malnutrition, aspiration and mortality. The identification of early screening parameters for dysphagia promptly leading to a professional swallowing examination is therefore of utmost importance. This study aimed to detect early and easily assessable predictors of dysphagia in a large cohort of patients with acute ischemic stroke. Methods: Our analysis was based on data from a prospective in-hospital registry. Patients with ischemic stroke were included over the course of 3 years. Patients were scheduled to undergo a clinical swallowing investigation within the first 24 h after hospital admission. Step-wise multivariate logistic regression was used to identify independent predictors of dysphagia in general and of pneumonia in particular. Results: 1,646 patients with ischemic stroke were included. Stroke severity in terms of higher National Institute of Health Stroke Scale (NIHSS) values (p < 0.001), male gender (p = 0.006) and higher age (p < 0.001) independently predicted dysphagia. A receiver operating characteristics analysis revealed an NIHSS cut-off value of 4.5 for optimal differentiation between patients with and without dysphagia (sensitivity 0.77; specificity 0.77). Dysphagia (p < 0.001), male gender (p = 0.002), higher NIHSS scores (p < 0.001) and higher age (p = 0.002) were factors that were independently associated with pneumonia. The NIHSS cut-off value for differentiating between patients with and without pneumonia was 5.5 (sensitivity 0.91; specificity 0.67). Conclusions: Stroke severity in terms of NIHSS is a simple and reliable predictor of dysphagia. Patients with NIHSS values ≥5 should be quickly directed towards a professional swallowing examination. Dysphagia was confirmed to be a strong predictor of pneumonia.

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Swallowing Disturbance Pattern Relates to Brain Lesion Location in Acute Stroke Patients

Cited by 114 publications

References 16 publications

Dysphagia Risk Assessment in Acute Left-Hemispheric Middle Cerebral Artery Stroke

Dysphagia Risk Assessment in Acute Left-Hemispheric Middle Cerebral Artery Stroke

Dysphagia following Acute Thalamic Haemorrhage: Clinical Correlates and Outcomes

Early Screening Parameters for Dysphagia in Acute Ischemic Stroke

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