Mihai Paul Glad, Otto Mareile, Domin Martin, Platz Thomas, Hamdy Shaheen, Lotze Martin
Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University Medicine, University of Greifswald, Germany.
BDH-Klinik Greifswald, Neurorehabilitation Centre and Spinal Cord Injury Unit, University of Greifswald, Germany.
Neuroimage Clin. 2016 May 10;12:1013-1021. doi: 10.1016/j.nicl.2016.05.006. eCollection 2016.
Neurogenic dysphagia frequently occurs after stroke and deglutitive aspiration is one of the main reasons for subacute death after stroke. Although promising therapeutic interventions for neurogenic dysphagia are being developed, the functional neuroanatomy of recovered swallowing in this population remains uncertain. Here, we investigated 18 patients post-stroke who recovered from dysphagia using an event related functional magnetic resonance imaging (fMRI) study of swallowing. Patients were characterized by initial dysphagia score (mild to severe), lesion mapping, white matter fractional anisotropy (FA) of the pyramidal tracts, and swallowing performance measurement during fMRI scanning. Eighteen age matched healthy participants served as a control group. Overall, patients showed decreased fMRI-activation in the entire swallowing network apart from an increase of activation in the contralesional primary somatosensory cortex (S1). Moreover, fMRI activation in contralesional S1 correlated with initial dysphagia score. Finally, when lesions of the pyramidal tract were more severe, recovered swallowing appeared to be associated with asymmetric activation of the ipsilesional anterior cerebellum. Taken together, our data support a role for increased contralesional somatosensory resources and ipsilesional anterior cerebellum feed forward loops for recovered swallowing after dysphagia following stroke.
神经源性吞咽困难在中风后经常出现，吞咽误吸是中风后亚急性死亡的主要原因之一。尽管针对神经源性吞咽困难的有前景的治疗干预措施正在研发中，但该人群吞咽功能恢复的功能性神经解剖学仍不明确。在此，我们使用吞咽事件相关功能磁共振成像（fMRI）研究，对18例从中风后吞咽困难中恢复的患者进行了调查。患者的特征包括初始吞咽困难评分（轻度至重度）、病变定位、锥体束的白质分数各向异性（FA）以及fMRI扫描期间的吞咽性能测量。18名年龄匹配的健康参与者作为对照组。总体而言，除了对侧初级体感皮层（S1）激活增加外，患者在整个吞咽网络中的fMRI激活均降低。此外，对侧S1中的fMRI激活与初始吞咽困难评分相关。最后，当锥体束病变更严重时，恢复的吞咽似乎与同侧前小脑的不对称激活有关。综上所述，我们的数据支持对侧体感资源增加和同侧前小脑前馈回路在中风后吞咽困难恢复中的作用。
