Department of Neurology, University of Muenster, Albert-Schweitzer-Str,33, 48149 Muenster, Germany.
BMC Neurol. 2011 Mar 11;11:34. doi: 10.1186/1471-2377-11-34.
Dysphagia is a major complication in hemispheric as well as brainstem stroke patients causing aspiration pneumonia and increased mortality. Little is known about the recovery from dysphagia after stroke. The aim of the present study was to determine the different patterns of cortical swallowing processing in patients with hemispheric and brainstem stroke with and without dysphagia in the early subacute phase.
We measured brain activity by mean of whole-head MEG in 37 patients with different stroke localisation 8.2+/-4.8 days after stroke to study changes in cortical activation during self-paced swallowing. An age matched group of healthy subjects served as controls. Data were analyzed by means of synthetic aperture magnetometry and group analyses were performed using a permutation test.
Our results demonstrate strong bilateral reduction of cortical swallowing activation in dysphagic patients with hemispheric stroke. In hemispheric stroke without dysphagia, bilateral activation was found. In the small group of patients with brainstem stroke we observed a reduction of cortical activation and a right hemispheric lateralization.
Bulbar central pattern generators coordinate the pharyngeal swallowing phase. The observed right hemispheric lateralization in brainstem stroke can therefore be interpreted as acute cortical compensation of subcortically caused dysphagia. The reduction of activation in brainstem stroke patients and dysphagic patients with cortical stroke could be explained in terms of diaschisis.
吞咽困难是半球性和脑干性卒中患者的主要并发症，可导致吸入性肺炎和死亡率增加。对于卒中后吞咽困难的恢复情况知之甚少。本研究旨在确定在早期亚急性期，有无吞咽困难的半球性和脑干性卒中患者的皮质吞咽处理的不同模式。
我们在卒中后 8.2+/-4.8 天对 37 例不同卒中定位的患者进行了全头 MEG 测量，以研究自我调节吞咽过程中皮质激活的变化。一个年龄匹配的健康受试者组作为对照组。数据通过综合孔径磁强计进行分析，并使用置换检验进行组分析。
我们的结果表明，半球性卒中伴吞咽困难的患者双侧皮质吞咽激活明显减少。在无吞咽困难的半球性卒中患者中，发现双侧激活。在较小的脑干卒中患者组中，我们观察到皮质激活减少和右侧偏侧化。
延髓中枢模式发生器协调咽期吞咽。因此，在脑干卒中患者中观察到的右侧偏侧化可以解释为亚皮质性吞咽困难的急性皮质补偿。脑干卒中患者和皮质性卒中伴吞咽困难患者的激活减少可以用去传入抑制来解释。
