Post stroke dysphagia and disability in minor strokes

Abstract

Minor strokes, defined as NIHSS ≤5 are considered non-disabling, associated with a favorable outcome. Our aim was to study patients presenting with minor stroke in the acute phase to see their medical complications and functional outcome on follow-up. Retrospective study design,where all minor strokes admitted to Stroke care centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum between January 2016-June 2017, with 1 year completed followup were selected from medical records. Clinical and imaging details and follow-up data were collected. We had 147 patients with minor stroke during the study period with median age 61 years. 71% presented within 24 hours of symptom onset.Median NIHSS at admission was 3 (IQR 2). 85 patients had anterior circulation strokes and 34 had chronic infarcts in imaging. At discharge, 19 had significant dysphagia, with 10 requiring nasogastric feeding. Admission NIHSS and white mater changes in imaging were predictive of post stroke dysphagia.Excellant recovery of dysphagia was found within 1 month post stroke in all, except one who required percutaneous gastrostomy. At 3 months, 76% had excellent outcome. In multivariate logistic regression analysis, presence of dysphagia and DM were found to be statistically significant predictors of short term outcome, ie at 3 months. At 12 months,post stroke dysphagia, females and those with white mater changes had a less favourable stroke outcome. Minor strokes are disabling in a small fraction of patients.Over 10% of them tend to have significant dysphagia necessitating nasogastric feeding short term.This patient subgroup tend to have less favourable outcome on short and long term followup.