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The Relationship Between Lesion Localization and Dysphagia in Acute Stroke

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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.

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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.

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Authors and Affiliations

  1. Research Service, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA

    Stephanie K. Daniels PhD

  2. Department of Communication Sciences and Disorders, University of Houston, 4455 Cullen Blvd, Houston, TX, 77204-6018, USA

    Stephanie K. Daniels PhD

  3. School of Public Health, University of Texas Health Sciences Center, 1200 Herman Pressler Blvd, Houston, TX, 77030, USA

    Shweta Pathak PhD & Robert O. Morgan PhD

  4. Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA

    Shalini V. Mukhi MD

  5. Diagnostic and Therapeutic Care Line, Michael E. DeBakey VA Medical Center, Holcombe Blvd, Houston, TX, 77030, USA

    Shalini V. Mukhi MD

  6. Speech Pathology Section, Operative Care Line, Michael E. DeBakey VA Medical Center, Holcombe Blvd, Houston, TX, 77030, USA

    Carol B. Stach MA

  7. Health Services Research and Development Center for Innovations in Quality, Effectiveness & Safety, Michael E. DeBakey VA Medical Center, Holcombe Blvd, Houston, TX, 77030, USA

    Jane A. Anderson PhD

  8. Department of Neurology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA

    Jane A. Anderson PhD

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  1. Stephanie K. Daniels PhD
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  2. Shweta Pathak PhD
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  3. Shalini V. Mukhi MD
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  4. Carol B. Stach MA
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  5. Robert O. Morgan PhD
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Correspondence to Stephanie K. Daniels PhD.

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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.

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Daniels, S.K., Pathak, S., Mukhi, S.V. et al. The Relationship Between Lesion Localization and Dysphagia in Acute Stroke. Dysphagia 32, 777–784 (2017). https://doi.org/10.1007/s00455-017-9824-0

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  • DOI: https://doi.org/10.1007/s00455-017-9824-0

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