The Relationship Between The Dysphagia And The Location And Size Of Acute Cerebral Infarction

Background:Cerebrovascular disease has been a serious condition threatening public health with high modality and disability rates. As one of its complication, Dysphagia could lead to aspirator pneumonia, dehydration, malnutrition, even death because of apnoea. The quality of patients'life decreases significantly and the health of patients are endangered greatly. At the same time, their families and society are brought serious economic and social burdens. There are many oversea studies on the assessment and diagnosis of dysphagia, however, the use of Videofluoroscopy to study the swallowing function isn't widespread in china. The occurrence of dysphagia after stroke was related to infarct location and volume. But it is not clear what the relevance between them is. This article will preliminarily explore the abnormal signs of dysphagia in post-stroke patients using videofluscopic swallowing study and analyze the relationship between location and size of cerebral infarction and dysphagia. This study maybe have some help to clinical prediction, screening, assessment and rehabilitation treatment of post-stroke dysphagia.Objective:1. To explore preliminarily the abnormal Videofluscopic signs of dysphagia in patients with acute stroke; To observe the frequency and correlative clinical feature of dysphagia following cerebral infarction. 2. To explore the relationship between the location and size of acute cerebral infarction and dysphagia. Methods:181 patients with acute cerebral infarction and six healthy volunteers accepted Videofluoroscopy swallowing Study (VFSS), and the Standardized Bedside Swallowing Assessment (SSA). Abnormal signs of swallowing were recorded. The subtype of dysphagia was divided into oral, pharynx and oropharynx phase three groups. According to the dysphagia severity, patients with dysphagia were divided into three groups: mild, moderate and serious. The infarction size and location were measured on MRI-DWI image. The coincidency of VFSS and SSA to diagnose dysphagia were compared. The major abnormal signs of VFSS were analyzed, The major differences between aspiration group and non-aspiration group were studied. The association of severity and subtype of post-stroke dysphagia with the infarct location and size was analyzed.Results: 1. Compared to the gold standard of VFSS, the sensitivity of SSA was 65.0% and the specificity of SSA was 77.0%. 2. Moderate/severe pharyngeal residue easily caused aspiration. 3. The incidence of dysphagia in patients with acute cerebral infarction was 66.3% (120/181), 67.7% (86/127) in anterior circulation infarct group(hemisphere infarct), 63.0% (34/54) in posterior circulation infarct group, and 88.6%(31/35) in brain stem infarct group. Dysphagia was not found in cerebellum infarct. 4. The incidence of dysphagia in multiple cerebral infarction was higher than that of cortex or basal ganglia, but the incidence of dysphagia in thalamus was lower than that of pons (p <0.05). Patients with anterior circulation infarct majorly showed oropharynx phase and oral phase dysphagia, posterior circulation infarct majorly showed pharynx phase dysphagia. The difference between these 2 group was statistically significant (p <0.05). The dysphagia types were not related to the location of anterior circulation infarct (p> 0.05). The left or right brain hemisphere infarction was not related to the types and incidence of dysphagia (p> 0.05). Patients with pontine infarct majorly showed pharynx phase dysphagia, and medullas infarct majorly showed oropharynx phase and oral phase dysphagia. The difference between these 2 group was statistically significant (p <0.05). 5. The infarction size of anterior or posterior circulation was not related to the types and incidence of dysphagia (p> 0.05). 6. The severity of dysphagia was closely related to infarct location and size. Severe dysphagia were found in patients with brainstem infarction and large-area cerebral infarction (P <0.001,0.05). 7. The dysphagia severity was not different in patients with left or right cerebral hemisphere infarction.(p> 0.05).Conclusion:1. Compared to the gold standard of VFSS, the method of SSA in assessment post-stroke dysphagia has consistency with it. However, its sensitivity and specificity are not high. 2. The incidence and types of dysphagia have relation to the location of acute cerebral infarction, but have no relation to the cerebral infarct size. The incidence of dysphagia in patients with multiple cerebral and brainstrem infarction is much higher. Patients with anterior circulation and medulla infarct majorly develop oropharynx phase dysphagia, pons infarct majorly develop pharynx phase dysphagia. 3. The incidence and severity of dysphagia was related to the location and size of acute cerebral infarction. Patients with the brainstem infarction and large-area cerebral infarction often have serious dysphagia.