Prognostic Prediction of Dysphagia by Analyzing the Corticobulbar Tract in the Early Stage of Intracerebral Hemorrhage

The Role of White Matter in the Neural Control of Swallowing: A Systematic Review

“…Ten of the 22 reviewed studies used a quantitative volume and voxel-based approach to record the location and size of lesions. These studies quantified damage by measuring lesion volume with voxels or mm 2 lesioned (Galovic et al, 2013 , 2016 , 2017 ; Suntrup et al, 2015 ; Mihai et al, 2016 ; Flowers et al, 2017 ; Fandler et al, 2018 ; Ko et al, 2019 ; Wilmskoetter et al, 2019 ; Jang et al, 2020a ) or they used these units to derive the amount of area or proportion (%) of an area that is lesioned (Suntrup et al, 2015 ). Three studies used a technique called voxel-based lesion symptom mapping (VLSM) (Bates et al, 2003 ), which enables calculation of correlations between locations of the “damaged” voxels and behavioral scores (Galovic et al, 2016 , 2017 ; Wilmskoetter et al, 2019 ).…”

“…Three of these papers directly aimed to investigate the contribution of the CBT in swallowing control. Two studies evaluated the predictive value of CBT damage on prognosis for dysphagia recovery (Jang et al, 2020a , b ). Specifically, Jang et al ( 2020a ) used tractography to measure FA and TV of the CBT in 42 patients with intracerebral hemorrhage and subsequent dysphagia requiring nasogastric tube (NGT) placement.…”

“…Two studies evaluated the predictive value of CBT damage on prognosis for dysphagia recovery (Jang et al, 2020a , b ). Specifically, Jang et al ( 2020a ) used tractography to measure FA and TV of the CBT in 42 patients with intracerebral hemorrhage and subsequent dysphagia requiring nasogastric tube (NGT) placement. Patients who recovered swallowing within 2 days had relatively minor damage to the CBT (only reduced FA, not reduced TV), whereas patients with longer NGT placement had more extensive damage to the CBT (both reduced FA and TV).…”

“…In patients with longer NGT placement (2 days to 6 months), CBT volume in the affected hemisphere was negatively correlated ( r = −0.430, p < 0.05) with length of time until NGT removal. Finally, none of the patients who had bilateral damage to the CBT were able to have their NGT removed within 6 months (Jang et al, 2020a ). In a separate study using similar methodology, Jang et al ( 2020b ) examined 20 patients with lateral medullary infarctions and found that CBT FA was significantly lower in patients with prolonged NGT placement (<6 months) compared to controls and to patients with shorter NGT placement durations (Jang et al, 2020b , p. 20).…”

“…However, when the analysis was restricted to patients with supratentorial damage, white matter hyperintensities did not remain significant risk factors (Fandler et al, 2017 ). Further, severity of damage to one specific white matter tract, the CBT, predicted prognosis for dysphagia recovery in two studies by Jang et al ( 2020a , b ).…”