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Functional lesions in dysphagia due to acute stroke: discordance between abnormal findings of bedside swallowing assessment and aspiration on videofluorography

  • Diagnostic Neuroradiology
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Abstract

Introduction

Bedside swallowing assessments are often used to assess dysphagia. However, in some patients, aspiration pneumonia occurs without any problems on bedside swallowing assessments and some patients do not suffer aspiration pneumonia despite abnormal results of bedside swallowing assessments in acute stroke. To detect the differences of lesions related to bedside swallowing assessment abnormality and aspiration, we investigated swallowing-related functional lesions in terms of cerebral blood flow in patients with dysphagia after stroke.

Methods

The study included 50 acute stroke patients who underwent bedside swallowing assessments and videofluorography as well as single-photon emission computed tomography (CT) at approximately the same time. Bedside swallowing assessments included repetitive saliva swallowing test and modified water swallowing test as dry and wet swallowing tasks. The presence or absence of aspiration was assessed using videofluorography. We divided patients into three subgroups based on the outcomes of the bedside swallowing assessments and presence or absence of aspiration. Statistical image analysis was performed using single-photon emission CT to determine their relationship with bedside swallowing assessments and videofluorography results.

Results

Twenty-seven (54.0 %) and 28 (56.0 %) patients had abnormal repetitive saliva swallowing test and modified water swallowing test results. Videofluorography indicated aspiration in 35 (70.0 %) patients. In comparing patients with and without abnormal results on each test, the groups with abnormal repetitive saliva swallowing test, abnormal modified water swallowing test, and aspiration demonstrated lower cerebral blood flow in the left precuneus, left insula, and anterior cingulate gyrus, respectively.

Conclusions

Based on the analysis of cerebral blood flow, functional lesions differed across abnormal repetitive saliva swallowing test and abnormal modified water swallowing test findings and aspiration on videofluorography, and each test may assess different functions among the many processes involved in swallowing.

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Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan

    Aiko Osawa & Shinichiro Maeshima

  2. Department of Nuclear Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan

    Hiroshi Matsuda

  3. Department of Neurology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan

    Norio Tanahashi

Authors
  1. Aiko Osawa
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  2. Shinichiro Maeshima
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  3. Hiroshi Matsuda
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  4. Norio Tanahashi
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Corresponding author

Correspondence to Shinichiro Maeshima.

Appendix

Appendix

Repetitive saliva swallowing test

The RSST is an assessment of the patient’s potential to swallow saliva. Patients were instructed by verbal command (sometimes by gesture) to swallow the saliva repeatedly for 30 s (forced swallowing). Based on the upper limit of cumulative swallowing rates in the elderly, twice or less per 30 s was defined as the screening value [11].

Modified water swallowing test

For the MWST, cold water (3 ml) was placed on the floor of the mouth using a 5-ml syringe; placement on the floor of the mouth prevented premature spillage into the pharynx. Patients were then instructed to swallow. If the patient was unable to swallow or experienced dyspnea, coughing, or wet–hoarse dysphonia after swallowing, a score was recorded (1 for inability to swallow, 2 for dyspnea, and 3 for cough or dysphonia), and the test was terminated. Otherwise, the patient was asked to perform two dry (saliva) swallows. If the patient was able to swallow the water but unable to perform either of the two dry swallows, a score of 4 was recorded. If the patient was able to complete the water and both dry swallows, a score of 5 was recorded. The entire procedure was repeated twice over, and the final score was defined as the lowest score on any trial. Ratings of 4 and 5 that represent no coughing or moist hoarseness after swallowing of water are normal [12].

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Osawa, A., Maeshima, S., Matsuda, H. et al. Functional lesions in dysphagia due to acute stroke: discordance between abnormal findings of bedside swallowing assessment and aspiration on videofluorography. Neuroradiology 55, 413–421 (2013). https://doi.org/10.1007/s00234-012-1117-6

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  • DOI: https://doi.org/10.1007/s00234-012-1117-6

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