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Introduction: A review of the literature yielded 11 supratentorial regions of interest (ROI) related to swallowing in healthy individuals. To assess the relevance of these structures for transient or prolonged dysphagia we performed a lesion study in ischemic stroke patients. Methods: Atlas-based localization analysis was performed using Talairach alignment of brain scans in consecutive patients with MRI-proven first-time acute supratentorial stroke. Standardized swallowing assessment was carried out within 48 hours and 8 to 10 days after hospitalization. Results: Prospective analysis of 86 patients demonstrated significant odds ratios (OR) of acute dysphagia (n=31) for: insular cortex (ICo, OR=6.4, p<0.001), internal capsule (ICa, OR=5.5, p=0.001), frontal operculum (FO, OR=3.9, p=0.004), caudal sensorimotor and premotor cortex (CSMPC, OR=3.7, p=0.005), superior temporal cortex (STC, OR=3.1, p=0.01), sensorimotor integration area (SMIA, BA 5/7, OR=2.8, p=0.04), periventricular white matter (PVWM, OR=2.7, p=0.03) and basal ganglia (BG, OR=2.6, p=0.04). Significant odds of prolonged dysphagia (>7 days, n=16) were demonstrated for: FO (OR=55.0, p<0.001), ICo (OR=27.0, p<0.001), CSMPC (OR=7.0, p=0.001), STC (OR=6.1, p=0.002), PVWM (OR=5.1, p=0.01) and SMIA (OR=4.0, p=0.01).
Conclusions: Stroke involving the insular cortex and the internal capsule shows the highest odds of acute dysphagia. Lesions of the frontal operculum and the insular cortex substantially increases the odds of prolonged dysphagia, whereas stroke of the internal capsule and the basal ganglia appears to cause only transient dysphagia. These areas may represent critical nodes in the neuronal network underlying swallowing and, thus, determine the dynamics of recovery after ischemic stroke.