Objective-To determine the incidence of dysphagia and associated pulmonary compromise in stroke patients through a systematic review of the published literature. Methods-Databases were searched (1966 through May 2005) using terms "cerebrovascular disorders," "deglutition disorders," and limited to "humans" for original articles addressing the frequency of dysphagia or pneumonia. Data sources included Medline, Embase, Pascal, relevant Internet addresses, and extensive hand searching of bibliographies of identified articles. Selected articles were reviewed for quality, diagnostic methods, and patient characteristics.Comparisons were made of reported dysphagia and pneumonia frequencies. The relative risks (RRs) of developing pneumonia were calculated in patients with dysphagia and confirmed aspiration. Results-Of the 277 sources identified, 104 were original, peer-reviewed articles that focused on adult stroke patients with dysphagia. Of these, 24 articles met inclusion criteria and were evaluated. The reported incidence of dysphagia was lowest using cursory screening techniques (37% to 45%), higher using clinical testing (51% to 55%), and highest using instrumental testing (64% to 78%). Dysphagia tends to be lower after hemispheric stroke and remains prominent in the rehabilitation brain stem stroke. There is increased risk for pneumonia in patients with dysphagia (RR, 3.17; 95% CI, 2.07, 4.87) and an even greater risk in patients with aspiration (RR, 11.56; 95% CI, 3.36, 39.77). Conclusions-The high incidence for dysphagia and pneumonia is a consistent finding with stroke patients. The pneumonia risk is greatest in stroke patients with aspiration. These findings will be valuable in the design of future dysphagia research.

SUMMARY Forty seven healthy young volunteers underwent defecographic examination to determine the range of normal findings. Normality was shown to encompass radiological features often considered pathological. These features included broad ranges of anorectal angle and pelvic floor descent which overlap with reported pathological states. Furthermore, the formation of rectocoeles during defecation was a very common finding in women. Finally, a subgroup of the volunteers had marginal anorectal function. The marginal anorectal function and certain radiological findings such as rectocoeles or intussusceptions may predispose to later problems, or contribute to clinical problems when combined with other factors such as dietary fibre deficiency. The radiological findings raise a number of questions with respect to different aspects of the functioning of the continence and defecation mechanisms.There has recently been increased interest in the investigation of problems of defecation and pelvic floor dysfunction using defecography (evacuation proctography). This procedure was first described by Burhenne in 1964' and April, 1986. Volunteers were recruited from the student population of the University of Toronto through advertisement at the Student Placement Offices. The recruiting advertisements explained only that the study was gastroenterological in nature and respondents were fully briefed when they applied. The respondents were excluded from the study if older than 35 years of age or there was a history of faecal incontinence, difficulties in defecation or past history of anorectal surgery. Forty eight subjects completed the study (23 women, 21 (1.6) (SD) yr; 25 men, 26 (4-8) yr). All the women were nulliparous.All subjects completed detailed questionnaires related to gastrointestinal and somatic symptoms, health habits and beliefs, affective status, and cognitive function. These details are not reported in this paper except as relates to the subjective report of bowel function.

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Functional magnetic resonance imaging (fMRI) provides a safe, noninvasive method for studying task-related cortical neuronal activity. Because the cerebral cortex is strongly implicated in the control of human swallowing, we sought to identify its functional neuroanatomy using fMRI. In 10 healthy volunteers, a swallow event-related paradigm was performed by injecting 5 ml water bolus into the oral cavity every 30 s. Whole brain functional magnetic susceptibility[Formula: see text]-weighted spiral imaging data were simultaneously acquired over 600 s on a 1.5-T magnetic resonance scanner, utilizing the blood oxygenation level-dependent technique, and correlation maps were generated using both >99% percentile rank and spatial extent thresholding. We observed areas of increased signal change consistently in caudal sensorimotor cortex, anterior insula, premotor cortex, frontal operculum, anterior cingulate and prefrontal cortex, anterolateral and posterior parietal cortex, and precuneus and superiomedial temporal cortex. Less consistent activations were also seen in posterior cingulate cortex and putamen and caudate nuclei. Activations were bilateral, but almost every region, particularly the premotor, insular, and frontal opercular cortices, displayed lateralization to one or the other hemisphere. Swallow-related cortical activity is multidimensional, recruiting brain areas implicated in processing motor, sensory, and attention/affective aspects of the task.

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