Purpose : Older patients with stroke have poor functional prognosis compared to younger patients. Patients with stroke who have severe white matter (WM) lesions have been reported to have swallowing problems. Recently, there is growing evidence suggesting that clinical significance can be indicated by the anatomic location of white matter lesions and whether the functional integrity of specific fiber bundles is affected. The aim of this study was to determine whether the location of WM lesions affects swallowing function in older patients with mild stroke.
Materials and Methods : We conducted a retrospective analysis of 88 patients aged >65 years who had a National Institutes of Health Stroke Scale (NIHSS) score ≤5 and who underwent videofluoroscopic swallowing examination after their first stroke. The involvement of CBT was determined by two trained researchers depending on the change of signal intensity at the location of CBT, almost halfway between the most anterior and the most posterior points of the lateral ventricle, almost one-third between the midline and the most lateral point of the brain, and anterior and medial compared with the corticospinal tract. Participants were divided into three groups according to the WM lesion's involvement of corticobulbar tract (CBT) as follows: group I, no involvement of CBT; group II, involvement of CBT in one hemisphere; and group III, involvement of CBT in both hemispheres.
Results : Significant differences were observed in the Fazekas grade (PVH), Fazekas grade (DWH), sum score of Fazekas grade, and the laryngeal elevation abnormality among three groups according to the CBT involvement. (Table 1) Statistically significant correlations were observed between the involvement of CBT and delayed pharyngeal transit time and inadequate laryngeal elevation. (Table 2) Linear regression analysis showed that pharyngeal transit time tended to increase according to the involvement of CBT in WM lesion (p=0.043). In addition, inadequate laryngeal elevation was related to the involvement of CBT (p=0.016). Early spillage, inadequate laryngeal elevation and penetration could also be predicted by Fazekas grade. (Table 3)
Conclusions : In summary, our results suggest that WM lesion location involving the CBT might affect the integrity of the tract that results in dysphasia in older patients with mild stroke, regardless of the initial stroke severity. Accordingly, the location of WM lesions can be regarded as a potential predictive factor for dysphagia. Moreover, in patients with WM lesions involving CBT, detailed evaluation of dysphagia is required. |
