Effect of Brain Lesions on Voluntary Cough in Patients with Supratentorial Stroke: An Observational Study.

Kyoung Bo Lee,Sun Im,Geun-Young Park,Seong Hoon Lim

doi:10.3390/brainsci10090627

Kyoung Bo Lee, Sun Im + Show 2 more

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https://doi.org/10.3390/brainsci10090627

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Abstract

Patients with stroke are known to manifest a decreased cough force, which is associated with an increased risk of aspiration. Specific brain lesions have been linked to impaired reflexive coughing. However, few studies have investigated whether specific stroke lesions are associated with impaired voluntary cough. Here, we studied the effects of stroke lesions on voluntary cough using voxel-based lesion-symptom mapping (VLSM). In this retrospective cross-sectional study, the peak cough flow was measured in patients who complained of weak cough (n = 39) after supratentorial lesions. Brain lesions were visualized via magnetic resonance imaging (MRI) at the onset of stroke. These lesions were studied using VLSM. The VLSM method with non-parametric mapping revealed that lesions in the sub-gyral frontal lobe and superior longitudinal and posterior corona radiata were associated with a weak cough flow. In addition, lesions in the inferior parietal and temporal lobes and both the superior and mid-temporal gyrus were associated with a weak peak cough flow during voluntary coughing. This study identified several brain lesions underlying impaired voluntary cough. The results might be useful in predicting those at risk of poor cough function and may improve the prognosis of patients at increased risk of respiratory complications after a stroke.

Highlights

Respiratory dysfunction and pneumonia are the leading causes of post-stroke hospitalization and high mortality [1]
The voxel-based lesion-symptom mapping (VLSM) method with non-parametric mapping revealed that lesions in the sub-gyral frontal lobe and superior longitudinal and posterior corona radiata were associated with a weak cough flow
The lesion volume showed significant correlations with other functional parameters such as the modified Barthel Index (MBI) and initial National Institutes of Health Stroke Scale (NIHSS) scores (Figure 4). The results of this VLSM study suggest that specific supratentorial lesions may be linked with decreased subjective cough weakness in patients diagnosed with stroke, confirming the findings of previous studies [6,7,11] implicating both cortical and subcortical regions in the control of voluntary cough (VC)

Summary

Introduction

Respiratory dysfunction and pneumonia are the leading causes of post-stroke hospitalization and high mortality [1]. Many patients with respiratory complications may manifest impaired cough reflex and a poor clearance of secretions, along with impairments in swallowing, which may increase the risk of aspiration. Coughing and swallowing involve coordinated but distinct oral, laryngeal, and respiratory muscles [2], they both share similar nerves and muscles with a significant overlap in their control mechanisms. Despite these similarities, it is still difficult to predict patients at risk of impaired cough, especially in those with swallowing disturbances. The early identification of those with impaired cough and, at risk of respiratory complications based on neuroimaging findings might be helpful. A cough may be produced in a reflexive or voluntary manner, both types prevent aspiration and protect the airway

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