The relationship between dysphagia in patients with supratentorial acute small subcortical infarcts and cerebral white matter lesions

Abstract

Dysphagia is commonly expected to occur in patients with severe stroke and large infarct size. However, to what extent dysphagia in acute penetrating branch infarction is still largely unknown. The aim of this study is to determine whether cerebral white matter (WM) lesions exert negative effects on swallowing function with acute small subcortical infarction. We identified all inpatients with magnetic resonance imaging between October 2015 and September 2017. This study included 20 supratentorial acute small subcortical infarction patients (mean age, 76.6 ± 11.9 years; 55% male) referred for dysphagia rehabilitation. They could communicate and had no sign of dysphagia before admission. Patients were excluded if their scans showed multiple acute subcortical infarcts, additional acute infarcts in other locations, or previous history of stroke. The patients were divided into the following two groups by their final food form: the swallowing recover group and the unchanged group. The severity of WM lesions was using fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging and rated based on the Fazekas scale, which categorizes WM lesions into four grades. The scale divides the WM lesions into periventricular and deep white matter lesions. We statistically examined the relationship between presence of dysphagia and severity of WM lesions. Dysphagia is present in a quarter of patients with supratentorial acute small subcortical infarcts and has to be expected especially in those with severe WM lesions. Many anatomic structures/pathways associated with swallowing function are located in subcortical regions and may not only be disrupted by small infarction but also by coexisting morphological damage such as cerebral WM lesions.