Ischemic lesion location based on the ASPECT score for risk assessment of neurogenic dysphagia

  • Dysphagia is common in patients with middle cerebral artery (MCA) infarctions and associated with malnutrition, pneumonia, and mortality. Besides bedside screening tools, brain imaging findings may help to timely identify patients with swallowing disorders. We investigated whether the Alberta stroke program early CT score (ASPECTS) allows for the correlation of distinct ischemic lesion patterns with dysphagia. We prospectively examined 113 consecutive patients with acute MCA infarctions. Fiberoptic endoscopic evaluation of swallowing (FEES) was performed within 24 h after admission for validation of dysphagia. Brain imaging (CT or MRI) was rated for ischemic changes according to the ASPECT score. 62 patients (54.9%) had FEES-proven dysphagia. In left hemispheric strokes, the strongest associations between the ASPECTS sectors and dysphagia were found for the lentiform nucleus (odds ratio 0.113 [CI 0.028–0.433; p = 0.001), the insula (0.275 [0.102–0.742]; p = 0.011), and the frontal operculum (0.280 [CI 0.094–0.834]; p = 0.022). A combination of two or even all three of these sectors together increased relative dysphagia frequency up to 100%. For right hemispheric strokes, only non-significant associations were found which were strongest for the insula region. The distribution of early ischemic changes in the MCA territory according to ASPECTS may be used as risk indicator of neurogenic dysphagia in MCA infarction, particularly when the left hemisphere is affected. However, due to the exploratory nature of this research, external validation studies of these findings are warranted in future.
Metadaten
Author:Sriramya Lapa, Christian Förch, Oliver Caspar Singer, Elke Hattingen, Sebastian Luger
URN:urn:nbn:de:hebis:30:3-636235
DOI:https://doi.org/10.1007/s00455-020-10204-0
ISSN:1432-0460
Parent Title (English):Dysphagia
Publisher:Springer
Place of publication:New York, NY
Document Type:Article
Language:English
Date of Publication (online):2020/11/06
Date of first Publication:2020/11/06
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2022/06/07
Tag:ASPECTS; Dysphagia; Pneumonia; Stroke; Swallowing
Volume:36
Issue:5
Page Number:9
First Page:882
Last Page:890
Note:
Open Access funding enabled and organized by Projekt DEAL. No special funding for this study.
HeBIS-PPN:495856169
Institutes:Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung 4.0