Videofluoroscopic swallow study in dysphagia stroke patients.

BACKGROUND AND

OBJECTIVES

Dysphagia is a common symptom of ischemic stroke. Severe complications include aspiration pneumonia, malnutrition, and dehydration. A videofluoroscopic swallow study (VFSS) allows for detailed dynamic and morphological examination of the swallowing act and therapy adjustment. Our study aimed to determine relationships between ischemic lesion locations and the character of swallowing disorder, as well as the frequency and severity of aspiration.

METHODS

This single-center retrospective study involved 27 post-stroke dysphagia patients, treated at our institution. The CT stroke examination protocol results of all patients were negative. They underwent brain magnetic resonance imaging (MRI), confirming the diagnosis of stroke and identifying the exact lesion location. Subsequently, all patients underwent VFSS with a modified barium swallow impairment profile (MBSImP) assessment, including calculating oral impairment (OI) and pharyngeal impairment (PI) variables. Aspiration was scored according to Rosenbek's Penetration-Aspiration Scale (PAS). We explored the relationships between OI, PI, and PAS variables and lesion locations.

RESULTS

Oral phase impairment (as represented by OI variables) differed significantly by lesion location, with greater impairment in supratentorial lesions (p < 0.001). Pharyngeal phase impairment showed no statistically significant differences by lesion location. Higher impairment in infratentorial lesion location was not statistically significant (p = 0.057). We found no corellation between supra- or infratentorial lesion location and the frequency or severity of aspiration.

CONCLUSION

The location of ischemic stroke lesions in the corticobulbar tract can indicate the character of the swallowing disorder to some extent. The oral phase is statistically significantly more affected in supratentorial lesions. Damage to the corticobulbar tract is often associated with aspiration, with an unclear relationship to the lesion location. Including VFSS in the diagnostic algorithm for dysphagic patients with mild or moderate stroke appears beneficial regardless of the lesion location.