BACKGROUND: Dysphagia is a major complication in hemispheric as well as brainstem stroke patients causing aspiration pneumonia and increased mortality. Little is known about the recovery from dysphagia after stroke. The aim of the present study was to determine the different patterns of cortical swallowing processing in patients with hemispheric and brainstem stroke with and without dysphagia in the early subacute phase. METHODS: We measured brain activity by mean of whole-head MEG in 37 patients with different stroke localisation 8.2+/-4.8 days after stroke to study changes in cortical activation during self-paced swallowing. An age matched group of healthy subjects served as controls. Data were analyzed by means of synthetic aperture magnetometry and group analyses were performed using a permutation test. RESULTS: Our results demonstrate strong bilateral reduction of cortical swallowing activation in dysphagic patients with hemispheric stroke. In hemispheric stroke without dysphagia, bilateral activation was found. In the small group of patients with brainstem stroke we observed a reduction of cortical activation and a right hemispheric lateralization. CONCLUSION: Bulbar central pattern generators coordinate the pharyngeal swallowing phase. The observed right hemispheric lateralization in brainstem stroke can therefore be interpreted as acute cortical compensation of subcortically caused dysphagia. The reduction of activation in brainstem stroke patients and dysphagic patients with cortical stroke could be explained in terms of diaschisis.
BACKGROUND:Dysphagia is a major complication in hemispheric as well as brainstem strokepatients causing aspiration pneumonia and increased mortality. Little is known about the recovery from dysphagia after stroke. The aim of the present study was to determine the different patterns of cortical swallowing processing in patients with hemispheric and brainstem stroke with and without dysphagia in the early subacute phase. METHODS: We measured brain activity by mean of whole-head MEG in 37 patients with different stroke localisation 8.2+/-4.8 days after stroke to study changes in cortical activation during self-paced swallowing. An age matched group of healthy subjects served as controls. Data were analyzed by means of synthetic aperture magnetometry and group analyses were performed using a permutation test. RESULTS: Our results demonstrate strong bilateral reduction of cortical swallowing activation in dysphagic patients with hemispheric stroke. In hemispheric stroke without dysphagia, bilateral activation was found. In the small group of patients with brainstem stroke we observed a reduction of cortical activation and a right hemispheric lateralization. CONCLUSION: Bulbar central pattern generators coordinate the pharyngeal swallowing phase. The observed right hemispheric lateralization in brainstem stroke can therefore be interpreted as acute cortical compensation of subcortically caused dysphagia. The reduction of activation in brainstem strokepatients and dysphagic patients with cortical stroke could be explained in terms of diaschisis.
Authors: S Li; C Luo; B Yu; B Yan; Q Gong; C He; L He; X Huang; D Yao; S Lui; H Tang; Q Chen; Y Zeng; D Zhou Journal: J Neurol Neurosurg Psychiatry Date: 2009-06-09 Impact factor: 10.154
Authors: O Steinstraeter; Inga K Teismann; A Wollbrink; S Suntrup; K Stoeckigt; R Dziewas; C Pantev Journal: Exp Brain Res Date: 2008-11-15 Impact factor: 1.972
Authors: Nelson H May; Jessica M Pisegna; Sarah Marchina; Susan E Langmore; Sandeep Kumar; William G Pearson Journal: J Stroke Cerebrovasc Dis Date: 2016-11-29 Impact factor: 2.136
Authors: Joel N Swerdel; Teresa M Janevic; William J Kostis; Ambarina Faiz; Nora M Cosgrove; John B Kostis Journal: Transl Stroke Res Date: 2016-05-23 Impact factor: 6.829