Abstract TP413: Prediction of Dysphagia Using the Alberta Stroke Program Early CT Score

Abstract

Background: Dysphagia is common in patients with acute middle cerebral artery (MCA) stroke, and associated with malnutrition, pneumonia and mortality. Hence, identification of patients with swallowing disorder early after stroke onset is important. Besides bedside screening tools, brain imaging findings including lesion size and location may be of value. We investigated whether The Alberta stroke program early CT score (ASPECTS) can be used to predict dysphagia, and whether differences exist herein between the left and the right hemisphere. Methods: The analysis was based on a prospective dataset of 113 patients with acute ischemic stroke in the MCA territory. 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. Results: 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 (ExpB 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). For right hemispheric strokes, only non-significant associations were found which were strongest for the insula region (0.385 [0.107-1.384]; p=0.144). For the left hemisphere multivariate logistic regression analysis revealed lower ASPECT scores to be independently associated with dysphagia, whereas for the right hemisphere this association was not present. Conclusion: The distribution and extent of early ischemic changes in brain imaging according to ASPECTS allows a reliable prediction of dysphagia in MCA-stroke patients, particularly for the left hemisphere.