M Galovic1,2, N Leisi3, M Müller3, J Weber4, B Tettenborn1, F Brugger1,5, E Abela6,7, B Weder1,7, G Kägi1. 1. Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland. 2. Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK. 3. Speech Pathology Service, Department of Otorhinolaryngology, Kantonsspital St Gallen, St Gallen, Switzerland. 4. Division of Neuroradiology, Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland. 5. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK. 6. Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland. 7. Support Centre for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital and University of Bern, Bern, Switzerland.
Abstract
BACKGROUND AND PURPOSE: Acute stroke patients with severely impaired oral intake are at risk of malnutrition and dehydration. Rapid identification of these patients is necessary to establish early enteral tube feeding. Whether specific lesion location predicts early tube dependency was analysed, and the neural correlates of impaired oral intake after hemispheric ischaemic stroke were assessed. METHODS: Tube dependency and functional oral intake were evaluated with a standardized comprehensive swallowing assessment within the first 48 h after magnetic resonance imaging proven first-time acute supratentorial ischaemic stroke. Voxel-based lesion symptom mapping (VLSM) was performed to compare lesion location between tube-dependent patients versus patients without tube feeding and impaired versus unimpaired oral intake. RESULTS: Out of 119 included patients 43 (36%) had impaired oral intake and 12 (10%) were tube dependent. Both tube dependency and impaired oral intake were significantly associated with a higher National Institutes of Health Stroke Scale score and larger infarct volume and these patients had worse clinical outcome at discharge. Clinical characteristics did not differ between left and right hemispheric strokes. In the VLSM analysis, mildly impaired oral intake correlated with lesions of the Rolandic operculum, the insular cortex, the superior corona radiata and to a lesser extent of the putamen, the external capsule and the superior longitudinal fascicle. Tube dependency was significantly associated with affection of the anterior insular cortex. CONCLUSIONS: Mild impairment of oral intake correlates with damage to a widespread operculo-insular swallowing network. However, specific lesions of the anterior insula lead to severe impairment and tube dependency and clinicians might consider early enteral tube feeding in these patients.
BACKGROUND AND PURPOSE: Acute strokepatients with severely impaired oral intake are at risk of malnutrition and dehydration. Rapid identification of these patients is necessary to establish early enteral tube feeding. Whether specific lesion location predicts early tube dependency was analysed, and the neural correlates of impaired oral intake after hemispheric ischaemic stroke were assessed. METHODS:Tube dependency and functional oral intake were evaluated with a standardized comprehensive swallowing assessment within the first 48 h after magnetic resonance imaging proven first-time acute supratentorial ischaemic stroke. Voxel-based lesion symptom mapping (VLSM) was performed to compare lesion location between tube-dependent patients versus patients without tube feeding and impaired versus unimpaired oral intake. RESULTS: Out of 119 included patients 43 (36%) had impaired oral intake and 12 (10%) were tube dependent. Both tube dependency and impaired oral intake were significantly associated with a higher National Institutes of Health Stroke Scale score and larger infarct volume and these patients had worse clinical outcome at discharge. Clinical characteristics did not differ between left and right hemispheric strokes. In the VLSM analysis, mildly impaired oral intake correlated with lesions of the Rolandic operculum, the insular cortex, the superior corona radiata and to a lesser extent of the putamen, the external capsule and the superior longitudinal fascicle. Tube dependency was significantly associated with affection of the anterior insular cortex. CONCLUSIONS: Mild impairment of oral intake correlates with damage to a widespread operculo-insular swallowing network. However, specific lesions of the anterior insula lead to severe impairment and tube dependency and clinicians might consider early enteral tube feeding in these patients.
Authors: Marian Galovic; Anne Julia Stauber; Natascha Leisi; Werner Krammer; Florian Brugger; Jochen Vehoff; Philipp Balcerak; Anna Müller; Marlise Müller; Jochen Rosenfeld; Alexandros Polymeris; Sebastian Thilemann; Gian Marco De Marchis; Thorsten Niemann; Maren Leifke; Philippe Lyrer; Petra Saladin; Timo Kahles; Krassen Nedeltchev; Hakan Sarikaya; Simon Jung; Urs Fischer; Concetta Manno; Carlo W Cereda; Josemir W Sander; Barbara Tettenborn; Bruno J Weder; Sandro J Stoeckli; Marcel Arnold; Georg Kägi Journal: JAMA Neurol Date: 2019-05-01 Impact factor: 18.302