Mapping acute lesion locations to physiological swallow impairments after stroke

Area of Science:

• Neuroscience
• Neurology
• Speech-Language Pathology

Background:

• Dysphagia is a common post-stroke complication, leading to serious health issues.
• The precise neuroanatomy of swallowing and the impact of stroke lesions remain unclear.

Purpose of the Study:

• To map acute stroke lesion locations to specific impairments in swallow physiology.
• To identify statistical relationships between brain damage and swallowing deficits.

Main Methods:

• Lesion symptom mapping was conducted on 68 acute ischemic stroke patients using MRI.
• Swallow physiology was assessed using the Modified Barium Swallow Study Impairment Profile (MBSImP©™).
• Voxel-based and region-based analyses identified associations between lesion sites and swallowing components.

Main Results:

• Specific swallowing aspects, including laryngeal elevation and pharyngeal residue, were significantly associated with lesion locations.
• Affected brain regions were predominantly in the right hemisphere, encompassing cortical and subcortical areas and white matter tracts.
• Distinct yet overlapping lesion sites were identified for different swallowing impairments.

Conclusions:

• Post-stroke swallowing physiology is linked to distinct neuroanatomical locations, mainly in the right hemisphere.
• Sensory-motor integration areas and their white matter pathways are crucial for swallowing function after stroke.
• Further research is needed to develop a neuroanatomical model and targeted treatments for post-stroke dysphagia.