Dysphagia in acute ischaemic stroke: severity, recovery and relationship to stroke subtype

Langdon, P. Claire; Lee, Andy H.; Binns, Colin

doi:10.1016/j.jocn.2006.04.009

Cited by 60 publications

(44 citation statements)

References 36 publications

(46 reference statements)

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“…Patients with lesions in the anterior cerebral circulation have a high incidence of dysphagia within the first week after the incident. When examined more closely, 75% of these patients experienced dysphagia two days after stroke and 90% of this subset persist with dysphagia after 1 week (30) . Infarctions involving the anterior cerebral artery are primarily responsible for dysphagia, because they affect important areas involved in swallowing (28) .…”

Section: Discussionmentioning

confidence: 99%

Association between neurological injury and the severity of oropharyngeal dysphagia after stroke

Otto

Ribeiro

Barea

et al. 2016

CoDAS

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Purpose: To associate the degree of biomechanical impairment in the swallowing process with the severity (National Institute of Health Stroke Scale -NIHSS) and type of neurological injury in patients post stroke. Methods: A cross-sectional, descriptive study conducted with 42 patients (22 females), aged 65.7 years on average diagnosed with stroke. All patients underwent clinical neurological evaluation and application of the NIHSS in the first 48 hours after stroke. The swallowing function was evaluated using the Functional Oral Intake Scale (FOIS) and the Protocol for the Investigation of Oropharyngeal Dysphagia in Adults. The Fisher's Exact Probability Test was used to assess the correlation between the degree of swallowing impairment and the severity (NIHSS score) and type of stroke. The study results were statistically analyzed at 5% significance level (p≤0.05). Results: 92.9% of the patients presented ischemic stroke; 59.5% presented impairment of the anterior cerebral circulation. Statistically significant correlation was found between the neurological scale (NIHSS) scores and the swallowing impairment scale (p=0.016). Conclusion: An association between stroke severity and oropharyngeal dysphagia severity was observed. A high proportion of patients with ischemic stroke with circulation affected in the anterior cerebral region presented severe oropharyngeal dysphagia. No statistically significant correlation was observed between the FOIS scale and stroke severity.

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Section: Discussionmentioning

confidence: 99%

Association between neurological injury and the severity of oropharyngeal dysphagia after stroke

Otto

Ribeiro

Barea

et al. 2016

CoDAS

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“…Patients with injuries in the anterior cerebral circulation present a high incidence of dysphagia within 1 week after the event, representing 75% of the patients with dysphagia 2 days after the stroke and 90% of those with persistent dysphagia after 1 week [35]. Infarctions involving the anterior cerebral artery are primarily responsible for dysphagia because they affect important areas participating in swallowing [25].…”

Section: Discussionmentioning

confidence: 99%

“…which could not be located). Studies have shown that patients with lacunar infarcts had no dysphagia in the days that followed the event, with only the need for a modification of food consistency [35]. Others have shown that the vertebrobasilar territory was more affected in patients with functional swallowing (43%), i.e.…”

Section: Discussionmentioning

confidence: 99%

Using the National Institute of Health Stroke Scale to Predict Dysphagia in Acute Ischemic Stroke

Okubo

Fábio²,

Domenis³

et al. 2012

Cerebrovasc Dis

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Background and Purpose: Oropharyngeal dysphagia is a common manifestation in acute stroke. Aspiration resulting from difficulties in swallowing is a symptom that should be considered due to the frequent occurrence of aspiration pneumonia that could influence the patient’s recovery as it causes clinical complications and could even lead to the patient’s death. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient. This study aimed to create an algorithm to identify patients at risk of developing dysphagia following acute ischemic stroke in order to be able to decide on the safest way of feeding and minimize the complications of stroke using the National Institutes of Health Stroke Scale (NHISS). Methods: Clinical assessment of swallowing was performed in 50 patients admitted to the emergency unit of the University Hospital, Faculty of Medicine of Ribeirão Preto, São Paulo, Brazil, with a diagnosis of ischemic stroke, within 48 h after the beginning of symptoms. Patients, 25 females and 25 males with a mean age of 64.90 years (range 26–91 years), were evaluated consecutively. An anamnesis was taken before the patient’s participation in the study in order to exclude a prior history of deglutition difficulties. For the functional assessment of swallowing, three food consistencies were used, i.e. pasty, liquid and solid. After clinical evaluation, we concluded whether there was dysphagia. For statistical analysis we used the Fisher exact test, verifying the association between the variables. To assess whether the NIHSS score characterizes a risk factor for dysphagia, a receiver operational characteristics curve was constructed to obtain characteristics for sensitivity and specificity. Results: Dysphagia was present in 32% of the patients. The clinical evaluation is a reliable method of detection of swallowing difficulties. However, the predictors of risk for the swallowing function must be balanced, and the level of consciousness and the presence of preexisting comorbidities should be considered. Gender, age and cerebral hemisphere involved were not significantly associated with the presence of dysphagia. NIHSS, Glasgow Coma Scale, and speech and language changes had a statistically significant predictive value for the presence of dysphagia. Conclusions: The NIHSS is highly sensitive (88%) and specific (85%) in detecting dysphagia; a score of 12 may be considered as the cutoff value. The creation of an algorithm to detect dysphagia in acute ischemic stroke appears to be useful in selecting the optimal feeding route while awaiting a specialized evaluation.

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“…The presence of dysphagia and aspiration, determined by clinical evaluation (18) or videofluoroscopy (46) , increases the risk of pulmonary infection. Aspiration followed by pneumonia is the most important complication of dysphagia, affecting 1/3 of all dysphagic patients (22) .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for swallowing dysfunction in stroke patients

Baroni

Fábio

Dantas

2012

Arq. Gastroenterol.

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-Context -Stroke is a frequent cause of dysphagia. Objective -To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. Methods -Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. Results -It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. Conclusions -Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death. HEADINGS -Stroke. Deglutition disorders.

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Dysphagia in acute ischaemic stroke: severity, recovery and relationship to stroke subtype

Cited by 60 publications

References 36 publications

Association between neurological injury and the severity of oropharyngeal dysphagia after stroke

Association between neurological injury and the severity of oropharyngeal dysphagia after stroke

Using the National Institute of Health Stroke Scale to Predict Dysphagia in Acute Ischemic Stroke

Risk factors for swallowing dysfunction in stroke patients

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