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The Relationship Between Lesion Localization and Dysphagia in Acute Stroke
Stephanie K Daniels1,2, Shweta Pathak3, Shalini V Mukhi4,5
1Research Service, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA. skdaniels@uh.edu.
Early stroke detection using diffusion-weighted MRI can identify patients at risk of airway invasion. However, lesion location may not predict dysphagia in mild stroke cases, highlighting the need for further research into race and stroke-related swallowing difficulties.
Area of Science:
- Neurology
- Swallowing Disorders
- Medical Imaging
Background:
- Early identification of dysphagia risk factors post-stroke is crucial for patient outcomes.
- Stroke location and hemisphere are potential indicators of swallowing impairment and airway invasion.
- Validated swallowing assessment tools are essential for accurate diagnosis.
Purpose of the Study:
- To investigate the association between stroke lesion location (hemisphere and specific site) and dysphagia patterns.
- To determine if diffusion-weighted magnetic resonance imaging (DW-MRI) findings can predict airway invasion in acute ischemic stroke patients.
- To explore the influence of race on stroke-related dysphagia severity and patterns.
Main Methods:
- Retrospective analysis of 80 patients with first-time acute ischemic stroke confirmed by DW-MRI.
- Assessment of swallowing function using the modified barium swallow impairment profile (MBSImP) for oral impairment (OI) and pharyngeal impairment (PI) scores.
- Evaluation of airway invasion using the Penetration Aspiration Scale (PAS).
- Regression models were used to analyze the relationship between lesion location, race, and swallowing outcomes.
Main Results:
- Infratentorial lesions were significantly associated with a higher likelihood of abnormal PAS scores (airway invasion) compared to right hemisphere lesions.
- White patients had a significantly higher likelihood of abnormal PAS scores compared to African American patients.
- African American patients exhibited higher (worse) OI scores compared to White patients.
- Pharyngeal impairment (PI) scores showed no significant association with race or lesion location.
Conclusions:
- DW-MRI can aid in identifying infratentorial strokes that increase the risk of airway invasion.
- Supratentorial infarct location and hemisphere information may not reliably predict dysphagia or aspiration risk in mild stroke.
- Further research is warranted to understand the role of race in the development of stroke-related dysphagia.
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