Advertisement

Dysphagia

, Volume 32, Issue 6, pp 777–784 | Cite as

The Relationship Between Lesion Localization and Dysphagia in Acute Stroke

  • Stephanie K. Daniels
  • Shweta Pathak
  • Shalini V. Mukhi
  • Carol B. Stach
  • Robert O. Morgan
  • Jane A. Anderson
Original Article

Abstract

Factors that can facilitate early identification of individuals at risk of dysphagia such as stroke location are potentially of great benefit. The aim of this study was to examine the role of hemisphere and lesion location in assessing dysphagia pattern and airway invasion as identified through the use of validated, standardized interpretation measures for the videofluoroscopic swallowing study. Consecutive patients (N = 80) presenting with stroke symptoms who had a first-time acute ischemic stroke confirmed on diffusion-weighted magnetic resonance imaging (DW-MRI) scan participated. Three swallowing outcome variables were assessed using regression models: modified barium swallow impairment profile (MBSImP) oral impairment (OI) and pharyngeal impairment (PI) scores and penetration aspiration scale (PAS) score. Subjects were primarily male and demonstrated mild stroke and mild to moderate dysphagia. There was a significantly higher likelihood of abnormal PAS scores for infratentorial lesions compared to right hemisphere location (Odds ratio: 3.1, SE: 1.8, p = 0.046) and for Whites compared to African Americans (Odds ratio: 5.5, SE: 2.6, p = <0.001). However, OI scores were higher (worse) in African Americans compared to Whites (Beta = −1.2; SE: 0.56; p = 0.037). PI scores had no significant association with race or lesion location. Using DW-MRI to identify infratentorial stroke can help identify individuals at risk of airway invasion; however, imaging information concerning supratentorial infarct hemisphere and location may not be useful to predict which individuals with mild stroke are at risk for dysphagia and aspiration when admitted with acute stroke symptoms. Future studies should explore the role of race in the development of stroke-related dysphagia.

Keywords

Deglutition Deglutition disorders Stroke Lesion localization Epidemiology 

Notes

Acknowledgements

The project described was based on work supported by a Merit Award (1I01RX000121) from the Rehabilitation Research & Development Service of the VA Office of Research and Development. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the University of Texas School of Public Health.

Compliance with ethical standards

Conflict of interest

Stephanie K. Daniels, Shweta Pathak, and Robert Morgan received salary support for a grant from the Department of Veterans Affairs. Shalini V. Mukhi, Carol B. Stach, and Jane A. Anderson report no conflict of interest.

References

  1. 1.
    Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63. doi: 10.1161/01STR.0000190056.76543.eb.CrossRefPubMedGoogle Scholar
  2. 2.
    Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal dysphagia screening protocols prevent pneumonia. Stroke. 2005;36:1972–6. doi: 10.1161/01.STR.0000177529.86868.8d.CrossRefPubMedGoogle Scholar
  3. 3.
    Odderson IR, McKenna BS. A model for management of patients with stroke during the acute phase. Outcomes and economic implications. Stroke. 1993;24:1823–7. doi: 10.1161/01.STR.24.12.1823.CrossRefPubMedGoogle Scholar
  4. 4.
    Martino R, Pron G, Diamont N. Screening for oropharyngeal dysphagia in stroke: insufficient evidence for guidance. Dysphagia. 2000;15:19–30. doi: 10.1007/s004559910006.CrossRefPubMedGoogle Scholar
  5. 5.
    Daniels SK, Foundas AL. Lesion localization in acute stroke. J Neuroimaging. 1999;9:91–8. doi: 10.1111/jon19999291.CrossRefPubMedGoogle Scholar
  6. 6.
    Cola MG, Daniels SK, Corey DM, Lemen LC, Romero M, Foundas AL. Relevance of subcortical stroke in dysphagia. Stroke. 2010;41:482–6. doi: 10.1161/STROKEAHA.109.566133.CrossRefPubMedGoogle Scholar
  7. 7.
    Gonzalez-Fernandez M, Kleinman JT, Ky PKS, Palmer JB, Hillis AE. Supratentorial regions of acute ischemia associated with clinically important swallowing disorders. Stroke. 2008;39:3022–8. doi: 10.1161/STROKE.AHA.108.518969.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Galovic M, Leisi N, Muller M, Weber J, Abela E, Kagi G, Weder B. Lesion location predicts transient and extended risk of aspiration after supratentorial ischemic stroke. Stroke. 2013;44:2760–7. doi: 10.1161/STROKE.AHA.113.001690.CrossRefPubMedGoogle Scholar
  9. 9.
    Suntrup S, Kemmling A, Warnecke T, Hamacher C, Oelenber S, Niederstadt T, Heindel W, Wiendl H, Dziewas R. The impact of lesion location on dysphagia incidence, pattern and complications in acute stroke. Part 1: dysphagia incidence, severity, and aspiration. Eur J Neurol. 2015;22:832–8. doi: 10.1111/ene.12670.CrossRefPubMedGoogle Scholar
  10. 10.
    Falsetti P, Acciai C, Palilla R, Bosi M, Carpinteri F, Zingarelli A, Pedace C, Lenzi L. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis. 2009;18:329–35. doi: 10.1016/j.jstrokecerebrovasdis.2009.01.009.CrossRefPubMedGoogle Scholar
  11. 11.
    Daniels SK, Foundas AL, Iglesia GC, Sullivan MA. Lesion site in unilateral stroke patients with dysphagia. J Stroke Cerebrovasc Dis. 1996;6:30–4. doi: 10.1016/S1052-3057(96)80023-1.CrossRefPubMedGoogle Scholar
  12. 12.
    Robbins J, Levine RL, Maser A, Rosenbek JC, Kempster GB. Swallowing after unilateral stroke of the cerebral cortex. Arch Phys Med Rehabil. 1993;74:1295–300. doi: 10.1016/0003-9993(93)90082-L.CrossRefPubMedGoogle Scholar
  13. 13.
    Alberts MJ, Horner J, Gray L, Brazer SR. Aspiration after stroke: lesion analysis by brain MRI. Dysphagia. 1992;7:170–3. doi: 10.1007/BF02493452.CrossRefPubMedGoogle Scholar
  14. 14.
    Jeon WH, Park GW, Lee JH, Jeong HJ, Sim YJ. Association between location of brain lesion and clinical factors and findings of videofluoroscopic swallowing study in subacute stroke patients. Brain Neurorehabil. 2014;7:54–60. doi: 10.12786/bn.2014.7.1.54.CrossRefGoogle Scholar
  15. 15.
    Daniels SK, Pathak S, Rosenbek JC, Morgan RO, Anderson JA. Rapid aspiration screening for suspected stroke: part 1: development and validation. Arch Phys Med Rehabil. 2016;97:1440–8. doi: 10.1016/j.apmr.2016.03.025.CrossRefPubMedGoogle Scholar
  16. 16.
    Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, Maxwell R, Blair J. MBS Measurement tool for swallow impairment-MBSImP: establishing a standard. Dysphagia. 2008;23:392–405. doi: 10.1007/s00455-008-9185-9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11:93–8. doi: 10.1007/BF00417897.CrossRefPubMedGoogle Scholar
  18. 18.
    Vatcheva KP, Lee MJ, Mccormick JB, Rahbar MH. Multicollinearity in regression analyses conducted in epidemiological studies. Epidemiology (Sunnyvale). 2016;6(2):227. doi: 10.4172/2161-1165.1000227.CrossRefGoogle Scholar
  19. 19.
    Vander Weele TJ, Robinson WR. On causal interpretation of race in regressions adjusting for confounding and mediating variables. Epidemiology (Cambridge). 2014;25:473–84. doi: 10.1097/EDE.0000000000000105.CrossRefGoogle Scholar
  20. 20.
    Miller AJ. The neuroscientific principles of swallowing and dysphagia. San Diego: Singular; 1999.Google Scholar
  21. 21.
    Kessler JP, Jean A. Identification of the medullary swallowing regions in rats. Exp Brain Res. 1985;57:256–63. doi: 10.1007/BF00236530.CrossRefPubMedGoogle Scholar
  22. 22.
    Jean A. Brain control of swallowing: neuronal network and cellular mechanisms. Physiol Rev. 2001;81:929–69.PubMedGoogle Scholar
  23. 23.
    Flowers HL, Skoretz SA, Streiner DL, Silver FL, Martino R. MRI-based neuroanatomical predictors of dysphagia after acute ischemic stroke: a systematic review and meta-analysis. Cerebrovasc Dis. 2011;32:1–10. doi: 10.1159/000324940.CrossRefPubMedGoogle Scholar
  24. 24.
    Vansant DH, Hamdy S. Cerebral cortical control of deglutition. In: Shaker R, Belafsky PC, Postma GN, Easterling C, editors. Principles of deglutition. New York: Springer; 2013.Google Scholar
  25. 25.
    Gonzalez-Fernandez M, Kuhlemeier KV, Palmer JB. Racial disparities in the development of dysphagia after stroke: analysis of the California (MIRCal) and New York (SPARCS) inpatient databases. Arch Phys Med Rehabil. 2008;89:1358–65. doi: 10.1016/j.apmr.2008.02.016.CrossRefPubMedGoogle Scholar
  26. 26.
    Bussell SA, Gonzalez-Fernandez M. Racial disparities in the development of dysphagia after stroke: further evidence from the medicare database. Arch Phys Med Rehabil. 2011;92:737–42. doi: 10.1016/j.apmr.2010.12.005.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2017

Authors and Affiliations

  • Stephanie K. Daniels
    • 1
    • 2
  • Shweta Pathak
    • 3
  • Shalini V. Mukhi
    • 4
    • 5
  • Carol B. Stach
    • 6
  • Robert O. Morgan
    • 3
  • Jane A. Anderson
    • 7
    • 8
  1. 1.Research ServiceMichael E. DeBakey VA Medical CenterHoustonUSA
  2. 2.Department of Communication Sciences and DisordersUniversity of HoustonHoustonUSA
  3. 3.School of Public HealthUniversity of Texas Health Sciences CenterHoustonUSA
  4. 4.Department of RadiologyBaylor College of MedicineHoustonUSA
  5. 5.Diagnostic and Therapeutic Care LineMichael E. DeBakey VA Medical CenterHoustonUSA
  6. 6.Speech Pathology Section, Operative Care LineMichael E. DeBakey VA Medical CenterHoustonUSA
  7. 7.Health Services Research and Development Center for Innovations in Quality, Effectiveness & SafetyMichael E. DeBakey VA Medical CenterHoustonUSA
  8. 8.Department of NeurologyBaylor College of MedicineHoustonUSA

Personalised recommendations