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Background and Aim
Early assessment for the risk of severe dysphagia is essential when planning therapeutic strategies in acute stroke patients. Nevertheless, the mechanisms underlying recovery of dysphagia are unclear to a large extent. We present the design and preliminary findings of an ongoing longitudinal prospective study as part of our long-term effort to analyze the pathogenesis of swallowing disorders and to determine reliable predictors of severe dysphagia in stroke patients.
Methods
Patients with MRI-proven first-ever acute ischemic stroke will be included. Prospective logopedic and neurologic evaluation of these patients and a standardized swallowing assessment will be carried out within (i) 48 hours and (ii) 8 to 10 days after hospitalization. Cases will be classified based on the well-validated clinical criteria established by Daniels et al. as prolonged dysphagia if the duration exceeds seven days; age matched controls will be subdivided into stroke patients with either transient dysphagia (duration between 48 hours to 7 days) and those without dysphagia. Data will be managed in a pseudonymized web-based data base. Lesions will be mapped onto diffusion weighted imaging scans and normalized into stereotaxic space. Voxel-wise subtractions will be calculated between subgroup lesion maps and a probabilistic cytoarchitectonic atlas will be used to quantify of lesion extent and location.
Data analysis
In an explorative analysis, clinical and neuroanatomical predictors will be established in patients (i) with vs. without acute dysphagia and in patients with (ii) prolonged vs. transient dysphagia. The incidence, characteristics, severity and prognosis of dysphagia in patients with isolated cortical, subcortical or brainstem lesions will be compared. Based on the obtained predictor variables a clinical score will be devised to predict the risk of prolonged dysphagia.
Potential significance
The identified cerebral and brainstem regions may determine the dynamics of recovery of dysphagia after ischemic stroke. These areas may represent critical nodes in the neuronal network underlying swallowing and, thus, shed new insights on the development and persistence of dysphagia. A better understanding of these clinical and MRI based predictors can improve the identification of patients at risk of prolonged dysphagia and, consequently, facilitate early decision making (e.g. placement of nasogastric tubes) in clinical routine.