Swallowing outcomes in patients with subcortical stroke associated with lesions of the caudate nucleus and insula

Abstract

ObjectiveThe present study was performed to investigate the relationships between swallowing outcomes and lesion location, bolus characteristics, and age in patients with subcortical stroke.Patients: Patients with subcortical and insular stroke (mean age, 57.38 ± 12.71 years) were investigated. All patients (n = 21) completed both brain magnetic resonance imaging studies and videofluoroscopic swallowing studies.Main Outcome MeasuresThe oral transit duration, pharyngeal transit duration (PTD), laryngeal response duration, and Penetration-Aspiration Scale (PAS) score were applied to examine the efficiency of propulsion and airway protection in three swallowing tasks. Path analyses were performed to assess the relationships between swallowing outcomes and lesion location, age, bolus viscosity, and bolus volume.ResultsCaudate nucleus (CN) lesions were associated with higher PAS scores. Insular lesions were associated with a longer PTD. Advanced age was associated with a longer PTD. Bolus viscosity significantly moderated the association between CN lesions and higher PAS scores.ConclusionsIn the present cohort, CN lesions impacted airway protection and insular lesions impacted pharyngeal transit. An increased bolus viscosity reduced the aspiration severity. These results suggest that lesion location is an important indicator to predict subsequent dysphagia in patients with subcortical stroke.

Relationships between Temporal Measurements and Swallowing Impairment in Unilateral Stroke Patients

“…In addition, stroke often causes deteriorations in sensory motor function, which can lead to longer swallowing initiation, decreased pharyngeal transport, and ineffective laryngeal protection (Mann, Hankey, & Cameron, 1999;Park, Kim, Ko, & McCullough, 2010;Seo, Oh, & Han, 2016). In demonstrating that advanced age is significantly associated with longer LRD, the results of the present study are in line with existing knowledge, and are similar to those of the prior investigation by Im, Jun, Hwang and Ko (2018) that showed a significant relationship between advanced age and longer LRD in subcortical stroke patients. Reduced swallowing efficiency in relation to longer swallowing duration has been a subject of discussion for a long time, and at least one reason for premature bolus loss in oropharyngeal swallowing impairment could be a longer LRD, especially with thin liquids (Kim & McCullough, 2007;Logemann et al, 1992;Park et al, 2010).…”

Increased activation of the caudate nucleus and parahippocampal gyrus in Parkinson’s disease patients with dysphagia after repetitive transcranial magnetic stimulation: a case-control study

“…The gradient of dopaminergic loss is largely preserved in all PD patients (Pasquini et al, 2019). Im et al (2018) and Kim et al (2019) showed that caudate damage can increase the risk of aspiration and prolong the recovery time of swallowing. Hence, caudate injury is likely involved in the occurrence of dysphagia in PD patients and is potentially associated with gradient changes in dopaminergic loss.…”

Effects of Insular Cortex on Post-Stroke Dysphagia: A Systematic Review and Meta Analysis

“…The median sample size was 95 (ranging from 20 to 342). Thirteen of the included studies were supratentorial strokes [ 11 , 12 , 13 , 17 , 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ], one infratentorial stroke [ 36 ], and seven both the supratentorial and infratentorial strokes [ 16 , 37 , 38 , 39 , 40 , 41 , 42 ]. Besides, subjects of sixteen studies were in acute phase of stroke [ 11 , 12 , 13 , 14 , 16 , 17 , 25 , 29 , 34 , 35 , 38 , 39 , 41 , 42 , 43 , 44 ], one was in subacute phase of stroke [ 30 ], and one was in chronic phase of stroke [ 28 ], while the stroke phases of the remaining six studies were unclear ( Table 1 ).…”

“…The swallowing assessment tools included the Water Swallowing Test (WST) [ 11 , 43 ], Videofluoroscopic Swallowing Study (VFSS) (taking up 37.5% of included studies) [ 12 , 24 , 28 , 30 , 31 , 36 , 38 , 39 , 40 ], Volume-viscosity Swallow Test (V-VST) (4.2%) [ 43 ], Fiberoptic Endoscopic Evaluation of Swallowing (FEES) (12.5%) [ 29 , 42 , 44 ], MBS impairment tool (MBSImP) (4.2%) [ 13 ], Standardized Clinical Assessment Tool (4.2%) [ 25 ], and Bogenhausen Dysphagia Score Part 2 (BDS-2) (4.2%) [ 35 ]. A total of thirteen articles described the days to the evaluation of PSD (ranging from 24 h to 4 weeks; Table 1 ).…”

“…The PSD-related lobar and deep brain regions included insular cortex (including the right, left, and anterior insular cortex) [ 11 , 13 , 14 , 16 , 17 , 24 , 25 , 29 , 31 , 35 , 37 , 39 , 41 ], which has been reported in 54.2% of included studies; frontal lobe (16.7%) (including superior frontal gyrus, inferior frontal gyrus, left inferior frontal lobe, right inferior frontal gyrus, middle frontal gyrus) [ 3 , 28 , 37 , 40 ]; temporal gyrus (4.2%) [ 11 ]; left and right basal ganglia (25%) (including right internal capsule, bilateral posterior limb of the internal capsule, lentiform nucleus) [ 11 , 28 , 29 , 34 , 37 , 38 ]; corona radiata (16.7%) (including left corona radiata and superior corona radiata) [ 13 , 16 , 25 , 34 ]; postcentral (12.5%) (including right primary sensory cortex) [ 13 , 16 , 44 ]; precentral (16.7%) (including left primary motor cortex, motor supplementary areas) [ 13 , 28 , 30 , 44 ]; precuneus (4.2%) [ 39 ] ( Table 3 and Figure 2 ).…”