Association between stroke lesions and videofluoroscopic findings in acute stroke patients

• Published in: Journal of neurology Vol. 268; no. 3; pp. 1025 - 1035
• Main Authors: Nakamori, Masahiro, Hosomi, Naohisa, Imamura, Eiji, Matsushima, Hayato, Maetani, Yuta, Yoshida, Mitsuyoshi, Yoshikawa, Mineka, Takeda, Chiho, Nagasaki, Toshikazu, Masuda, Shin, Kayashita, Jun, Tsuga, Kazuhiro, Tanimoto, Keiji, Wakabayashi, Shinichi, Maruyama, Hirofumi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2021; Springer Nature B.V
• Subjects: Basal ganglia; Dementia disorders; Lesions; Magnetic resonance imaging; Medicine; Medicine & Public Health; Multivariate analysis; Neurology; Neuroradiology; Neurosciences; Oral cavity; Original Communication; Parietal lobe; Pharynx; Stroke; Swallowing; Tongue; Dysphagia; Stroke lesion; Videofluoroscopic examination; Acute stroke
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-020-10244-4

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.