Dysphagia After Stroke

Abstract

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.

Swallowing disorders after ischemic stroke

“…by clinical means or by using instruments like videofluoroscopy or endoscopy. Thus, studies have shown a range from 18 to 81% [3][4][5]10,14,22 .…”

“…dence ranging from 18% to 81% in the acute phase and with prevalence of 12% among such patients [3][4][5] . Studies making objective assessments through swallowing examinations have shown that the prevalence of aspiration may reach 55%, and that around 45% of the cases result in death 6,7 .…”

“…Studies making objective assessments through swallowing examinations have shown that the prevalence of aspiration may reach 55%, and that around 45% of the cases result in death 6,7 . Among the most frequent complications of dysphagia are increased mortality, pulmonary risks such as aspiration pneumonia, dehydration, malnutrition and long-term hospitalization 3,4,8,9 . Surveys have shown that the predictors of dysphagia in clinical assessments include older age, greater severity of stroke, wet vocal quality, abnormal palatal reflex, weak or absent cough, abnormal voluntary cough, coughing with swallowing and injury sustained in controlling secretions 9,10 .…”

“…Regarding the topography of the lesion, it is important to show that cortical lesions may give rise to difficulty in controlling the voluntary movements of chewing, thus impairing transportation of the food bolus during the oral and pharyngeal phase of swallowing, and increasing the chances of tracheal aspiration. Brainstem lesions are less frequent, but result in severe impairment of swallowing because of the location of most of the nuclei of the cranial nerves 3,11,12 .…”

Autonomic symptoms in hypertensive patients with post-acute minor ischemic stroke

“…Hypertensive patients without symptomatic stroke showed significantly higher scores than healthy subjects for urinary, cardiovascular and sudomotor domains. Factors like medication and presence of silent stroke may contribute to those symptoms; hypertension is strongly associated with silent brain infarction that may produce subtle deficits in cognitive and physical function [30].…”