Lesion site in unilateral stroke patients with dysphagia

doi:10.1016/S1052-3057(96)80023-1

Journal of Stroke and Cerebrovascular Diseases

Volume 6, Issue 1, September–October 1996, Pages 30-34

https://doi.org/10.1016/S1052-3057(96)80023-1 Get rights and content

The purpose of this retrospective study was to elucidate specific lesion sites associated with deglutition disorders by studying unilateral left- and right-hemispheric stroke patients with dysphagia. We reviewed computed tomography and magnetic resonance imaging scans and videofluoroscopic swallow studies of 16 consecutive patients with unilateral ischemic infarcts and dysphagia. Results suggest that unilateral hemispheric lesions may produce dysphagia and that patients with left- and right-hemispheric strokes may have different dysphagia characteristics. Although right-hemispheric lesions were significantly smaller than left-hemispheric lesions, dysphagia seemed to be clinically more significant in patients with right-hemispheric strokes, because a higher incidence of delayed pharyngeal swallow (consistency specific) and pharyngeal stasis was recorded in this population. Cytoarchitectonic lesion mapping showed that the insular cortex was the commonest lesion site, suggesting that the insula may be important in swallowing. A prospective double-blind study in a larger sample of unilateral stroke patients with and without dysphagia is warranted to confirm these preliminary findings.

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Cited by (101)

Correlation between lesion location and dysphagia characteristics in post-stroke patients
2024, Journal of Stroke and Cerebrovascular Diseases
To assess the correlation between lesion location and swallowing function characteristics in post-stroke dysphagia (PSD) patients.
We enrolled 133 PSD. The patients were divided into supratentorial and infratentorial stroke groups. We compared the measurements in the videofluoroscopic swallowing study (VFSS) with 3ml and 5 ml of diluted and thickened barium liquid data between supratentorial and brainstem stroke groups. We further compared the difference of VFSS measurements between patients with left hemispheric or right hemispheric lesions (further divided into unilateral hemispheric cortical and subcortical subgroups) and brianstem leison stroke group.To explore the lesion location's effect on different bolus volume, the VFSS measurements of 3ml and 5ml in each subgroups were compared respectively. The measurements of VFSS included the oral transit time, soft palate elevation duration, hyoid bone movement duration (HMD), UES opening duration, pharyngeal transit duration (PTD), stage of ansition duration, and laryngeal closure duration (LCD), the upper esophageal sphincter opening (UESO), hyoid bone superior horizontal displacement, and hyoid bone anterior horizontal displacement. General swallowing function was assessed using the Penetration Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS). We performed the paired t-test, Spearman's correlation, and Kruskal–Wallis test analysis to characterize the parameters among the groups.
Fifty-eight patients were assessed in the final analysis. The HMD (p = 0.019), PTD (p = 0.048) and LCD (p = 0.013) were significantly different between the supratentorial and brainstem lesion groups in 5ml volume. The HMD was significantly different (p = 0.045) between the left cortical and brainstem lesion groups. Significant differences in the HMD (p = 0.037) and LCD (p = 0.032) between the left subcortical and brainstem lesion groups were found in 5ml volume bolus. There was no group different when taking the 3ml volume bolus. Regarding the relationship between food bolus volume and swallowing functions, only the UESO demonstrated a significant difference in the subcortical lesion of the right hemisphere (p = 0.0032) compared the 3 ml and 5 ml volume bolus. The PTD demonstrated a moderate correlation with the PAS scores (r = 0.38, p = 0.0044). The HMD (r = 0.32, p = 0.018) and LCD (r = 0.29, p = 0.039) demonstrated weak correlations with the PAS scores. We did not identify any correlation between the VFSS parameters and FOIS scores in each subgroup level.
The PSD with brainstem lesion shows more sever dysfunction in the pharyngeal phases. The left hemisphere was engaged in both the oral and pharyngeal phases. Lesions in the bilateral cortical, subcortical, and brainstem regions may impair sensory input.
Hemodynamic signal changes during volitional swallowing in dysphagia patients with different unilateral hemispheric stroke and brainstem stroke: A near-infrared spectroscopy study
2024, Brain Research Bulletin
Strokes will result in decreased in cortical excitability and changed in the balance between the affected and unaffected hemispheres. Previous studies have focused on cortical changes in healthy subjects during swallowing, while they remain unknown in patients with stroke at different locations. Thus, the purpose of this study was to research cortical activation patterns of swallowing in patients with dysphagia and healthy subjects by the functional near-infrared spectroscopy (fNIRS). We also focus on the comparability of brain activation areas associated with swallowing between patients with different stroke locations and healthy subjects.
total of 104 participants were invited to our study, involving 86 patients with dysphagic unilateral hemispheric stroke and 18 age and sex matched healthy controls. The stroke patients were categorized into patients with left unilateral stroke lesions (n = 30), patients with right unilateral stroke lesions (n = 32) and patients with brainstem injury (n = 24) according to different stroke sites. All patients underwent a series of clinical swallowing function assessments, such as the Fiberoptic endoscopic dysphagia severity scale (FEDSS), penetration-aspiration scale (PAS) of Rosenbek, the gugging swallowing screen (GUSS) and the functional oral Intake scale (FOIS) after informed consent has been signed. All participants received the fNIRS system assessment.
The results showed that extensive areas of the cerebral cortex activated during the swallowing tasks in healthy participants (P < FDR 0.05). For patients with left unilateral stroke lesions, the HbO concentration were strongest over the right hemisphere (P < FDR 0.05). In addition, a less severe activation was also observed in the left hemisphere. Comparable to patients with left unilateral stroke lesions, the strongest activation during swallowing task were found in the left hemisphere in patients with right unilateral stroke lesions (P < FDR 0.05). Similarly, the right hemisphere also has activated less. In contrast, patients with brain stem injury showed more bilaterally activation patterns.
Our finding states that cortical activation areas differ between patients with different stroke locations and healthy subjects during swallowing. There was a more bilateral activation in healthy participants and patients with lesions in the brainstem while more cortical activation in unaffected hemisphere in patients with unilateral hemispheric stroke. It also provides a basis for the future treatment of dysphagia after stroke.
Conceptualizing Adult Dysphagia in the United States Within the International Classification of Functioning, Disability and Health (ICF)
2024, Archives of Physical Medicine and Rehabilitation
Despite the well-documented safety concerns and effect on quality of life, there does not yet exist a wide-reaching framework that links the etiologies of swallowing disorders to the potential short- and long-term outcomes in the context of International Classification of Functioning, Disability and Health (ICF). This paper introduces an expert-reviewed conceptual framework to highlight common etiologies of dysphagia as well as integrate immediate outcomes of dysphagia with long-term outcomes of dysphagia in terms of medical problems, health-related quality of life, functional effect, and psychosocial features. It also outlines the potential cyclical nature of long-term dysphagia outcomes perpetuating the original dysphagia. This framework serves to inform clinicians of important dysphagic outcomes and to bring awareness to long-term outcomes that should be monitored by health care professionals, caregivers, or people with dysphagia.
Cerebral control of swallowing: An update on neurobehavioral evidence
2022, Journal of the Neurological Sciences
Citation Excerpt :
The effects of a unilaterally lesioned hemisphere have been the center of debate in studies of cerebral control of swallowing. Some studies have reported no association between the side of the lesioned hemisphere and dysphagia severity or characteristics [37,38,48–50], while others have reported hemispheric bias [39–41,47,51–53]. Most of these studies report that right hemispheric lesions result in more severe dysphagia involving pharyngeal impairments [47,51,52].
This review aims to update the current knowledge on the cerebral control of swallowing. We review data from both animal and human studies spanning across the fields of neuroanatomy, neurophysiology and neuroimaging to evaluate advancements in our understanding in the brain's role in swallowing. Studies have collectively shown that swallowing is mediated by multiple distinct cortical and subcortical regions and that lesions to these regions can result in dysphagia. These regions are functionally connected in separate groups within and between the two hemispheres. While hemispheric dominance for swallowing has been reported in most human studies, the laterality is inconsistent across individuals. Moreover, there is a shift in activation location and laterality between swallowing preparation and execution, although such activation changes are less well-defined than that for limb motor control. Finally, we discussed recent neurostimulation treatments that may be beneficial for dysphagia after brain injury through promoting the reorganization of the swallowing neural network.
Lesion location and other predictive factors of dysphagia and its complications in acute stroke
2019, Clinical Nutrition ESPEN
Early detection of dysphagia is crucial in stroke patients as a result of increased morbidity and mortality due to malnutrition and respiratory tract infections. The aim of this study was to identify possible predictors of the onset of dysphagia following stroke in order to be able to act precociously.
Observational, prospective study in which a Volume-Viscosity Swallow Test (V-VST) was carried out in the first 72 h following admission to assess dysphagia in acute stroke patients with a previous result of <3 in the Eating Assessment Tool-10. Lesions were analysed by computed tomography and/or magnetic resonance, using the ABC/2 formula to calculate their volume. Likewise, 3-month follow-up was carried out for the evaluation of the occurrence of respiratory tract infections and deaths.
Out of 106 patients admitted for acute stroke, 60 (56.60%) presented dysphagia (44.40% showing alterations in the effectiveness of swallowing and 33.30% in its safety). The factors that were related to dysphagia were: older age (76.40 ± 11.50 vs 66.37 ± 13.85 years, p = 0.0001), stroke severity as measured on the National Institute of Health Stroke Scale (6.81 ± 5.83 vs 3.38 ± 3.46, p = 0.001) and greater volume of the lesion (23.47 ± 47.15 vs 7.50 ± 14.53 ml, p = 0.042). The variables that were influenced by a greater lesion size were the presence of cough, oxygen desaturation and impaired labial seal. Dysphagia was not affected by the lateralization of the lesion or by the type of stroke (ischaemic/haemorrhagic). Despite the fact that 68.80% of the patients with a temporoparietal lesion presented dysphagia, no significant differences were observed regarding the location of the lesion in the regions studied. 27.3% of the patients with frontal lesions presented respiratory infections after discharge (p = 0.018), a condition which was also observed in 20.0% of patients with dysphagia (p = 0.044). Mortality during the 3-month follow-up period was 20.0% for patients with a positive V-VST (p = 0.005), due to respiratory infection in 66.6% of the cases (p = 0.0001).
Post-stroke dysphagia was associated with the occurrence of respiratory tract infection and mortality. Our study also provides more information about how certain demographic and clinical factors, as well as neuroimaging patterns, influence dysphagia. This fact may help to identify at an early stage those patients with a greater risk of developing swallowing alterations.
Reduced tongue force and functional swallowing changes in a rat model of post stroke dysphagia
2019, Brain Research
Citation Excerpt :
The MCAO group was compared with a sham-surgery group to control for surgical effects on lingual function and swallowing, however alternative surgical approaches may be less invasive (Hill and Nemoto, 2014) and should be considered for future studies. Unilateral stroke of either cerebral hemisphere can produce dysphagia (Daniels et al., 1996; Li et al., 2009; Robbins and Levine, 1988; Wilmskoetter et al., 2018). Many studies have attempted to determine differential effects of stroke location on swallowing function and have reported mixed results (Daniels et al., 1999; Dehaghani et al., 2016; Marian et al., 2017; Robbins et al., 1993; Steinhagen et al., 2009; Suntrup et al., 2015; Theurer et al., 2008).
Dysphagia is a common problem after stroke that is often associated with tongue weakness. However, the physiological mechanisms of post-stroke tongue muscle weakness and optimal treatments have not been established. To advance understanding of physiological mechanisms of post stroke dysphagia, we sought to validate the unilateral transient middle cerebral artery occlusion (MCAO) rat model of ischemic stroke as a translational model of post stroke dysphagia. Our goal was to establish clinically relevant measures and chronicity of functional deficits; criteria that increase the likelihood that findings will translate to the clinic. We hypothesized that MCAO would cause tongue weakness and functional swallowing changes.
Maximum voluntary tongue forces and videofluoroscopic swallowing studies were collected in 8-week old male Sprague-Dawley rats prior to receiving either a left MCAO (N = 10) or sham (N = 10) surgery. Tongue forces and VFSS were reassessed at 1 and 8 weeks post-surgery.
Maximum voluntary tongue force, bolus area, and bolus speed were significantly reduced in the MCAO group at the 1 and 8-week timepoints.
Clinically relevant changes to swallowing and tongue force support the use of the MCAO rat model as a translational model of post stroke dysphagia. This model will allow for future studies to improve our understanding of the physiology contributing to these functional changes as well as the impact of therapeutic interventions on physiological targets and function.

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Lesion site in unilateral stroke patients with dysphagia*

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