Stroke Lesion Location Is Associated with Dynamic Inspiratory Performance: A Cross-Sectional Study

We examined whether respiratory performance differed among broad stroke lesion-location categories.

This exploratory single-center cross-sectional analysis combined pre-intervention assessments from 20 participants in an earlier trial with 60 subsequently recruited participants. The 80 patients were classified into frontal lobe (n = 27), basal ganglia region (n = 26), or brainstem (n = 27) categories. Peak inspiratory flow (PIF), strength index (S-Index), and five conventional respiratory outcomes were assessed. Holm correction was applied across seven outcomes. Linear models used type 3 heteroscedasticity-consistent (HC3) robust standard errors and the original six clinical covariates. Additional PIF analyses incorporated time since stroke, National Institutes of Health Stroke Scale (NIHSS), or modified Barthel Index (MBI), and restricted the sample to ischemic or first-ever stroke.

Only PIF retained an unadjusted group association after Holm correction (adjusted p = 0.008). The adjusted overall lesion-location association also survived correction (adjusted p = 0.009). PIF was 0.625 L/s higher in the basal ganglia region than in the brainstem group (95% confidence interval [CI], 0.282-0.967). This contrast persisted with additional clinical adjustment in the full cohort and in ischemic stroke. Evidence weakened in first-ever stroke; with MBI adjustment, the contrast was 0.381 L/s (95% CI, -0.067-0.829).

Broad lesion-location categories were associated with PIF in this selected cohort. The findings remain exploratory and cannot fully separate anatomical associations from stroke severity, disability, unmeasured clinical factors, or measurement limitations.