Galovic Marian, Leisi Natascha, Pastore-Wapp Manuela, Zbinden Martin, Vos Sjoerd B, Mueller Marlise, Weber Johannes, Brugger Florian, Kägi Georg, Weder Bruno J
Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, UK National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, WC1N 3BG.
Hum Brain Mapp. 2017 Apr;38(4):2165-2176. doi: 10.1002/hbm.23511. Epub 2017 Jan 13.
Knowledge about the recovery of oral intake after hemispheric stroke is important to guide therapeutic decisions, including the administration of enteral tube feeding and the choice of the appropriate feeding route. They aimed to determine the localization and connectivity of lesions in impaired recovery versus recovered swallowing after initially dysphagic stroke. Sixty-two acute ischemic hemispheric stroke patients with impaired oral intake were included in a prospective observational cohort study. Voxel-based lesion-symptom mapping and probabilistic tractography were used to determine the association of lesion location and connectivity with impaired recovery of oral intake ≥7 days (indication for early tube feeding) and ≥4 weeks (indication for percutaneous endoscopic gastrostomy feeding) after stroke. Two distinct patterns influencing recovery of swallowing were recognized. Firstly, impaired recovery of oral intake after ≥7 days was significantly associated with lesions of the superior corona radiata (65% of statistical map, P < 0.05). The affected fibers were connected with the thalamus, primary motor, and supplemental motor areas and the basal ganglia. Secondly, impaired recovery of oral intake after ≥4 weeks significantly correlated with lesions of the anterior insula (54% of statistical map, P < 0.05), which was connected to adjacent operculo-insular areas of deglutition. These findings indicate that early swallowing recovery is influenced by white matter lesions disrupting thalamic and corticobulbar projection fibers. Late recovery is determined by specific cortical lesions affecting association fibers. This knowledge may help clinicians to identify patients at risk of prolonged swallowing problems that would benefit from enteral tube feeding. Hum Brain Mapp 38:2165-2176, 2017. © 2017 Wiley Periodicals, Inc.
了解半球性卒中后经口进食功能的恢复情况对于指导治疗决策非常重要，包括肠内管饲的实施以及合适喂养途径的选择。他们旨在确定最初吞咽困难的卒中患者中，吞咽功能恢复受损与恢复正常者的病变定位和连接情况。62例经口进食功能受损的急性缺血性半球性卒中患者纳入一项前瞻性观察队列研究。采用基于体素的病变-症状映射和概率性纤维束成像来确定病变位置和连接性与卒中后经口进食功能恢复受损≥7天（早期管饲指征）和≥4周（经皮内镜下胃造口术喂养指征）之间的关联。识别出两种影响吞咽功能恢复的不同模式。首先，≥7天后经口进食功能恢复受损与放射冠上部病变显著相关（统计图的65%，P<0.05）。受影响的纤维与丘脑、初级运动区、辅助运动区和基底神经节相连。其次，≥4周后经口进食功能恢复受损与岛叶前部病变显著相关（统计图的54%，P<0.05），该区域与相邻的吞咽岛盖区相连。这些发现表明，早期吞咽功能恢复受破坏丘脑和皮质延髓投射纤维的白质病变影响。晚期恢复则由影响联合纤维的特定皮质病变决定。这些知识可能有助于临床医生识别有长期吞咽问题风险且能从肠内管饲中获益的患者。《人类脑图谱》38:2165 - 2176，2017年。©2017威利期刊公司。
