Abstract
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.
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Data availability
The data that support the findings of this study are available from the corresponding author on reasonable request.
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Acknowledgements
We would like to sincerely thank the staff at the Suiseikai Kajikawa Hospital for their technical assistance.
Funding
This study was supported by research Grants from the Japan Society for the Promotion of Science KAKENHI (Grant numbers 18K10746).
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Hirofumi Maruyama reports research support from Eisai, Pfizer, Takeda Pharmaceutical, Otsuka Pharmaceutical, Nihon Pharmaceutical, Shionogi, Teijin Pharma, Fuji Film, Boehringer Ingelheim, Sumitomo Dainippon Pharma, Nihon Medi-Physics, Bayer, MSD, Daiichi Sankyo, Kyowa Hakko Kirin, Sanofi, Novartis, Kowa Pharmaceutical, Astellas Pharma, Tsumura, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Mylan, which are unrelated to the submitted work. All other authors declare that they have no conflicts of interest.
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The study protocols were approved by the ethics committee of Suiseikai Kajikawa Hospital and were in accordance with the guidelines of the national government based on the Helsinki Declaration of 1964.
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Written informed consent was obtained from all patients or their relatives. All data analyses were blinded.
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Nakamori, M., Hosomi, N., Imamura, E. et al. Association between stroke lesions and videofluoroscopic findings in acute stroke patients. J Neurol 268, 1025–1035 (2021). https://doi.org/10.1007/s00415-020-10244-4
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DOI: https://doi.org/10.1007/s00415-020-10244-4