Brain regions involved in swallowing: Evidence from stroke patients in a cross-sectional study

Abstract

Background:Limited data available about the mechanisms of dysphagia and areas involving swallow after brain damage; accordingly it is hard to predict which cases are more likely to develop swallowing dysfunction based on the neuroimaging. The aim of this study was to investigate the relationship between brain lesions and dysphagia in a sample of acute conscious stroke patients.Materials and Methods:In a cross-sectional study, 113 acute conscious stroke patients (69 male mean [standard deviation (SD)] age 64.37 [15.1]), participated in this study. Two neurologists and one radiologist localized brain lesions according to neuroimaging of the patients. Swallowing functions were assessed clinically by an expert speech pathologist with the Mann Assessment of Swallowing Ability (MASA). The association of brain region and swallowing problem was statistically evaluated using Chi-square test.Results:Mean (SD) MASA score for the dysphagic patients was 139.61 (29.77). Swallowing problem was significantly more prevalent in the right primary sensory (P = 0.03), right insula (P = 0.005), and right internal capsule (P = 0.05).Conclusion:It may be concluded from these findings that the right hemisphere lesions associated with occurring dysphagia. Further studies using more advanced diagnostic tools on big samples particularly in a perspective structure are needed.

Prevalence, recovery and phenotype of dysphagia in patients with ischaemic cerebellar stroke

“…Our data show that dysphagia can occur in ischaemic cerebellar stroke with a prevalence of about 13%. To date, conflicting data exist about whether lesions only in the cerebellum could in general lead to post-stroke dysphagia [5][6][7][8][9]. Reasons for hitherto inconclusive results might be related to patient selection and number of cases.…”

Clinical Effects and Differences in Neural Function Connectivity Revealed by MRI in Subacute Hemispheric and Brainstem Infarction Patients With Dysphagia After Swallowing Therapy

“…In normal subjects, Babaei et al ( 2013 ) and Malandraki et al ( 2009 ) used brain fMRI to demonstrate increased activation in the cingulate, insula, sensorimotor cortex, prefrontal and parietal cortices, cerebellum, and thalamus during swallowing. Furthermore, Vahdat et al ( 2011 ) observed that alterations in the functional connectivity of the sensorimotor network may be related to motor learning and the importance of the role of somatosensory region in swallowing had been gradually discovered (Babaei et al, 2013 ; Dehaghani et al, 2016 ; Mihai et al, 2016 ). In the present study, stroke patients received a variety of treatments to improve their swallowing, including motor functional training, thermal stimulation, postural compensation, oropharyngeal exercise, compensatory techniques, and swallowing maneuver.…”

“…Previous studies have used clinical observations, EEG, magnetoencephalography (MEG) or transcranial magnetic stimulation (TMS) to explore the cerebral areas associated with swallowing dysfunction (Robbins et al, 1993 ; Hamdy et al, 1997 ; Luan et al, 2013 ; Jestrovic et al, 2016 ). However, over recent years, functional magnetic resonance imaging (fMRI) has become a more popular tool with which to evaluate cerebral cortical function during volitional and reflexive swallowing in humans (Hamdy et al, 1999 ; Mosier K. et al, 1999 ; Mosier K. M. et al, 1999 ; Kern et al, 2001 ; Martin et al, 2001 ; Malandraki et al, 2011 ; Dehaghani et al, 2016 ). Li et al used fMRI to investigate cerebral cortical activation during swallowing with tasks in acute dysphagic stroke patients involving of unilateral hemisphere (Li et al, 2009 ).…”

The efficacy and safety of catheter balloon dilatation in the treatment of dysphagia after stroke: A protocol for systematic review and meta-analysis

“…Risk factors for dysphagia include Older age, [6,7] Greater NIHSS, [6–11] Lower Barthel index, [12,13] Malnutrition or lower body mass index at admission, [12,14,15] Greater lesion volume, [10,11,16,17] Subcortical or cortical involvement, [18–20] Brainstem involvement, [9,18,19,21–24] Corticobulbar tract involvement, [13,25] White matter involvement, [9,13,25] Presence of dysarthria, [16,22] Presence of dysphonia or reduced maximum pitch, [16,26] and Cognitive impairment or dementia. [27,28]…”

“…The neural circuit that produces the swallowing pattern is located in the medulla oblongata. [5] Risk factors for dysphagia include Older age, [6,7] Greater NIHSS, [6][7][8][9][10][11] Lower Barthel index, [12,13] Malnutrition or lower body mass index at admission, [12,14,15] Greater lesion volume, [10,11,16,17] Subcortical or cortical involvement, [18][19][20] Brainstem involvement, [9,18,19,[21][22][23][24] Corticobulbar tract involvement, [13,25] White matter involvement, [9,13,25] Presence of dysarthria, [16,22] Presence of dysphonia or reduced maximum pitch, [16,26] and Cognitive impairment or dementia. [27,28] The consequences of dysphagia after a stroke include an increased risk of pulmonary complications, dehydration, malnutrition, and death.…”