Masahiro Nakamori1,2, Naohisa Hosomi3,4,5, Eiji Imamura2, Hayato Matsushima2, Yuta Maetani1,2, Mitsuyoshi Yoshida6, Mineka Yoshikawa6, Chiho Takeda6, Toshikazu Nagasaki7, Shin Masuda8, Jun Kayashita9, Kazuhiro Tsuga6, Keiji Tanimoto7, Shinichi Wakabayashi10, Hirofumi Maruyama1. 1. Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. 2. Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan. 3. Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. nhosomi@hiroshima-u.ac.jp. 4. Department of Neurology, Chikamori Hospital, Kochi, Japan. nhosomi@hiroshima-u.ac.jp. 5. Department of Disease Model, Research Institute of Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan. nhosomi@hiroshima-u.ac.jp. 6. Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan. 7. Department of Oral and Maxillofacial Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan. 8. Department of Children Sensory, Hiroshima Prefectural Hospital, Hiroshima, Japan. 9. Department of Health Sciences, Faculty of Human Culture and Sciences, Prefectural University of Hiroshima, Hiroshima, Japan. 10. Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan.
Abstract
BACKGROUND AND PURPOSE: We aimed to assess stroke lesions, which play a key role in determining swallowing dysfunction, and findings of videofluoroscopy (VF), which provides the most accurate instrumental assessment for evaluating swallowing function, in patients with acute stroke. METHODS: We enrolled 342 patients with first-time acute stroke (age 70.4 ± 12.6 years, 142 female). Patients with dementia and altered mental status due to severe stroke were excluded. All patients underwent cranial magnetic resonance imaging to identify the location of stroke lesion, VF, and tongue pressure measurement. RESULTS: Aspiration was detected in 45 (13.2%) patients. Multivariate analysis identified parietal lobe lesion and the National Institutes of Health Stroke Scale (NIHSS) score as independent significant factors for aspiration (odds ratio 6.33, 95% confidence interval [CI] 2.25-17.84, p < 0.001; odds ratio 1.12, 95% CI 1.03-1.20, p = 0.004, respectively). Swallowing reflex delay was detected in 58 (17.0%) patients. Multivariate analysis identified habitual drinking, basal ganglia lesion, and the NIHSS score as independent significant factors for swallowing reflex delay (odds ratio 0.51, 95% CI 0.26-0.99, p = 0.047; odds ratio 1.91, 95% CI 1.09-3.67, p = 0.041; odds ratio 1.12, 95% CI 1.05-1.20, p < 0.001, respectively). Additionally, oral cavity and pharyngeal residues were independently associated with tongue pressure. CONCLUSION: Parietal lobe lesions are associated with aspiration and basal ganglia lesions with swallowing reflex delay.
BACKGROUND AND PURPOSE: We aimed to assess stroke lesions, which play a key role in determining swallowing dysfunction, and findings of videofluoroscopy (VF), which provides the most accurate instrumental assessment for evaluating swallowing function, in patients with acute stroke. METHODS: We enrolled 342 patients with first-time acute stroke (age 70.4 ± 12.6 years, 142 female). Patients with dementia and altered mental status due to severe stroke were excluded. All patients underwent cranial magnetic resonance imaging to identify the location of stroke lesion, VF, and tongue pressure measurement. RESULTS: Aspiration was detected in 45 (13.2%) patients. Multivariate analysis identified parietal lobe lesion and the National Institutes of Health Stroke Scale (NIHSS) score as independent significant factors for aspiration (odds ratio 6.33, 95% confidence interval [CI] 2.25-17.84, p < 0.001; odds ratio 1.12, 95% CI 1.03-1.20, p = 0.004, respectively). Swallowing reflex delay was detected in 58 (17.0%) patients. Multivariate analysis identified habitual drinking, basal ganglia lesion, and the NIHSS score as independent significant factors for swallowing reflex delay (odds ratio 0.51, 95% CI 0.26-0.99, p = 0.047; odds ratio 1.91, 95% CI 1.09-3.67, p = 0.041; odds ratio 1.12, 95% CI 1.05-1.20, p < 0.001, respectively). Additionally, oral cavity and pharyngeal residues were independently associated with tongue pressure. CONCLUSION:Parietal lobe lesions are associated with aspiration and basal ganglia lesions with swallowing reflex delay.