Purpose
Given an understanding of suggested role of the cerebellum in motor coordination, timing, sequencing, and feedback, it is natural to suspect a supportive role for the cerebellum in swallowing-related functions. The role for the cerebellum in deglutiotion has become increasing evident, but with few data from pure cerebellar lesions, exact nature of this role remains not inconclusive. The aim of this study was to investigate the characteristics and risk factors of dysphagia assessed with the Videofluoroscopic Dysphagia Scale (VDS) using a videofluoroscopic swallowing study (VFSS) in patients with the isolated lesion in cerebellum. We also aimed to define the lesion location associated with the dysphagia after adjusting for other relevant factors using VLSM.
Materials and methods
The inclusion criteria were as follows: 1) first-ever stroke restricted to the cerebellum, 2) age 18 years or older, 3) elapsed time of 3 months or less after stroke onset. The exclusion criteria were as follows: (1) missing medical record or brain MRI scans; (2) previous history of stroke, dementia, or other disease that could cause difficulty in swallowing, and (3) severe cognitive deficit (Mini-Mental Status Examination (MMSE) scores <10 points). Ultimately, a total of 40 patients satisfied the criteria and were chosen for analysis. Data from these patients were collected retrospectively. Characteristics of dysphagia were evaluated using VFSS and all subjects were divided into a high (>47) and low risk group (<47) by the VDS score. VLSM analysis identified clusters of voxels with statistically significant t-values comparing voxelwise subject clinical measures (VDS) with lesions to those without lesions. Uncorrected threshold results associated with the VDS for semisolid food were presented to show which lesioned areas were trending.
Results
The insertion of tracheal tube, the presence of IVH, K-MMSE, and initial FIM score differed significantly between the two subgroups. (Table 1) The parameter-K-MMSE was independently predisposing for dysphagia after stroke in patients with cerebellar lesions. (Table 2) Using VLSM, we found the lesion location to be associated with. Although these results did not reach statistical significance, they showed the lesion pattern with predominant distribution in the left posterior lobe. (Fig 1)
Conclusion
In isolated cerebellar lesion, majority of patients had the swallowing disturbance, both in oral phase and pharyngeal phase. Especially, in cognitively disturbed patients, dysphagia could be predicted. When adjusting for cognitive function, there was tendency for the lesion responsible for dysphagia to be located in the left posterior cerebellar hemisphere, though the association did not reach significance.
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