Ischemic Lesion Location Based on the ASPECT Score for Risk Assessment of Neurogenic Dysphagia
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ORIGINAL ARTICLE
Ischemic Lesion Location Based on the ASPECT Score for Risk Assessment of Neurogenic Dysphagia Sriramya Lapa1 · Christian Foerch1 · Oliver C. Singer1 · Elke Hattingen2 · Sebastian Luger1 Received: 4 May 2020 / Accepted: 19 October 2020 © The Author(s) 2020
Abstract Dysphagia is common in patients with middle cerebral artery (MCA) infarctions and associated with malnutrition, pneumonia, and mortality. Besides bedside screening tools, brain imaging findings may help to timely identify patients with swallowing disorders. We investigated whether the Alberta stroke program early CT score (ASPECTS) allows for the correlation of distinct ischemic lesion patterns with dysphagia. We prospectively examined 113 consecutive patients with acute MCA infarctions. 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. 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 (odds ratio 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). A combination of two or even all three of these sectors together increased relative dysphagia frequency up to 100%. For right hemispheric strokes, only nonsignificant associations were found which were strongest for the insula region. The distribution of early ischemic changes in the MCA territory according to ASPECTS may be used as risk indicator of neurogenic dysphagia in MCA infarction, particularly when the left hemisphere is affected. However, due to the exploratory nature of this research, external validation studies of these findings are warranted in future. Keywords Dysphagia · Swallowing · Stroke · ASPECTS · Pneumonia
Introduction Dysphagia is common among patients with acute ischemic stroke with a reported incidence of up to 78% [1]. It is associated with an increased rate of in-hospital complications (such as malnutrition and aspiration pneumonia) and with unfavorable long-term functional outcome [2, 3]. Therefore, early identification of patients with post-stroke dysphagia is of utmost importance in order to guide decisions concerning Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00455-020-10204-0) contains supplementary material, which is available to authorized users. * Sebastian Luger [email protected] 1
Department of Neurology, Neurovascular Research Group, Goethe University Hospital Frankfurt, Schleusenweg 2‑16, 60528 Frankfurt, Germany
Institute of Neuroradiology, Goethe University, Frankfurt, Germany
2
nutrition status, drug administration and necessity of further instrumental diagnostics (e.g., fiberoptic endoscopic evaluation of swallowing and/or videofluoroscopic swallowing study). Consequently, the current standard of st
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