Relevance of Subcortical Stroke in Dysphagia

• Published in: Stroke (1970) Vol. 41; no. 3; pp. 482 - 486
• Main Authors: COLA, Monique G, DANIELS, Stephanie K, COREY, David M, LEMEN, Lisa C, ROMERO, Maryellen, FOUNDAS, Anne L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-03-2010
• Subjects: Aged; Biological and medical sciences; Brain - pathology; Deglutition Disorders - diagnosis; Deglutition Disorders - etiology; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Middle Aged; Nerve Fibers, Myelinated - pathology; Nervous system (semeiology, syndromes); Neurology; Stroke - complications; Stroke - diagnosis; Vascular diseases and vascular malformations of the nervous system; Stroke; Nervous system diseases; Esophageal disease; Cardiovascular disease; White matter; Cerebral disorder; Vascular disease; periventricular white matter; Central nervous system disease; ENT disease; Digestive diseases; Dysphagia; Subcortex; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/strokeaha.109.566133

Unilateral cortical lesions are associated with dysphagia in ischemic stroke. It is unclear, however, whether acute subcortical stroke is associated with a similar risk of dysphagia. The aim of this study was to determine the occurrence of dysphagia in purely subcortical stroke and identify dysphagia characteristics.
Between 2003 and 2005, videofluoroscopic swallow studies (VFSSs) were completed in 20 consecutive ischemic stroke patients with purely subcortical lesions (right hemisphere damage [RHD]=10, left hemisphere damage [LHD]=10) and 25 age-matched controls. Individuals were classified with dysphagia when at least 2 swallowing measures were 2 standard deviations above mean scores for the control group. Lesion volume, hemisphere, and location were determined from diffusion-weighted magnetic resonance imaging scans.
Seven subcortical stroke patients (35%) met VFSS criteria for dysphagia (LHD=5, RHD=2); 4 patients presented with clinically significant dysphagia. A significant interaction between hemisphere and lesion location was identified. Whereas 3 of 5 patients with dysphagia (60%) had lesions to the left periventricular white matter (PVWM), LHD patients without dysphagia did not have PVWM lesions. In contrast, no RHD patients with PVWM lesions had dysphagia, and 6 of 8 patients without dysphagia (75%) had PVWM lesions. Oral transfer was significantly slower in patients with subcortical stroke compared with the healthy adults.
Lesions to the left PVWM may be more disruptive to swallowing behavior than similar lesions to the right PVWM. Swallowing deficits involving oral control and transfer may be a marker of subcortical neural axis involvement.