Abstract
BackgroundThis study was performed to identify the association between the total magnetic resonance imaging burden of small vessel disease and the occurrence of post-stroke dysphagia in patients with a single recent small subcortical infarct (RSSI).MethodsWe retrospectively identified all patients with a magnetic resonance imaging-confirmed single RSSI. The water-swallowing test and volume-viscosity swallow test were performed within the first 24 h following admission to assess swallowing. Demographic and clinical data were extracted from our stroke database. Based on brain magnetic resonance imaging, we independently rated the presence of cerebral microbleeds, lacunes, white matter hyperintensities and enlarged perivascular spaces. The presence of each small vessel disease feature was summed to determine the total small vessel disease burden, ranging from 0 to 4.ResultsIn total, 308 patients with a single RSSI were enrolled. Overall, 54 (17.5%) were diagnosed with post-stroke dysphagia. The risk factors related to post-stroke dysphagia included the following: older age, higher National Institute of Health Stroke Scale scores, higher C-reactive protein level and higher fibrinogen level. Based on multiple logistic regression, National Institute of Health Stroke Scale scores and total small vessel disease burden were independent risk factors of post-stroke dysphagia in patients with a single RSSI, after adjusting for age, gender, history of hypertension, C-reactive protein level and fibrinogen level.ConclusionsDysphagia in patients with a single RSSI was associated with a more severe total small vessel disease burden as reflected by MRI. Total MRI of cerebral small vessel disease burden may predict dysphagia in these patients. Furthermore, more severe total small vessel disease burden was associated with systemic inflammation.
Highlights
Post stroke dysphagia (PSD) is defined as difficulty in swallowing after stroke
The selection criteria were as follows: (1) diagnosis of acute ischemic stroke (AIS) confirmed by diffusion-weighted Magnetic resonance imaging (MRI) (DWI); and (2) diagnosis of a single recent small subcortical infarct (RSSI) according to the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE) consensus criteria [21] by two neuroimaging experts blinded to the clinical data
More severe total small vessel disease burden was associated with systemic inflammation
Summary
Post stroke dysphagia (PSD) is defined as difficulty in swallowing after stroke. PSD is a common disabling symptom associated with pneumonia, malnutrition and poor clinical outcomes [1]. Zhang et al BMC Neurology (2022) 22:1 older, or have severe stroke and larger infarcts [2] Brainstem strokes represent another risk factor for dysphagia and result in the most severe impairment of swallowing [3]. PSD occurs in up to one-fifth of patients with a single recent small subcortical infarct (RSSI) [4]. Another study identified severe stroke, pontine infarcts and severe WMHs as risk factors for swallowing dysfunction in patients with a single RSSI [4]. This study was performed to identify the association between the total magnetic resonance imaging burden of small vessel disease and the occurrence of post-stroke dysphagia in patients with a single recent small subcortical infarct (RSSI)
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