Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC 29425, USA; Department of Neurology, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC 29425, USA.
Department of Neurology, College of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC 29425, USA.
Neuroimage Clin. 2019;22:101685. doi: 10.1016/j.nicl.2019.101685. Epub 2019 Jan 22.
Dysphagia is a common deficit after a stroke, and it is frequently associated with pneumonia, malnutrition, dehydration, and poor quality of life. It is not yet fully clear which brain regions are directly related to swallowing, and how lesions affect swallow physiology. This study aimed to assess the statistical relationship between acute stroke lesion locations and impairment of specific aspects of swallow physiology. We performed lesion symptom mapping with 68 retrospectively recruited, acute, first-ever ischemic stroke patients. Lesions were determined on diffusion weighted MRI scans. Post-stroke swallow physiology was determined using the Modified Barium Swallow Study Impairment Profile (MBSImP©™). The relationship between brain lesion location and 17 physiological aspects of swallowing were tested using voxel-based and region-based statistical associations corrected for multiple comparisons using permutation thresholding. We found that laryngeal elevation, anterior hyoid excursion, laryngeal vestibular closure, and pharyngeal residue were associated with lesioned voxels or regions of interests. All components showed distinct and overlapping lesion locations, mostly in the right hemisphere, and including cortical regions (inferior frontal gyrus, pre- and postcentral gyrus, supramarginal gyrus, angular gyrus, superior temporal gyrus, insula), subcortical regions (thalamus, amygdala) and white matter tracts (superior longitudinal fasciculus, corona radiata, internal capsule, external capsule, ansa lenticularis, lenticular fasciculus). Our findings indicate that different aspects of post-stroke swallow physiology are associated with distinct lesion locations, primarily in the right hemisphere, and primarily including sensory-motor integration areas and their corresponding white matter tracts. Future studies are needed to expand on our findings and thus, support the development of a neuroanatomical model of post-stroke swallow physiology and treatment approaches targeting the neurophysiological underpinnings of swallowing post stroke.
吞咽障碍是中风后的常见后遗症，常与肺炎、营养不良、脱水和生活质量下降有关。目前还不完全清楚哪些大脑区域与吞咽直接相关，以及病变如何影响吞咽生理。本研究旨在评估急性中风病变部位与吞咽生理特定方面损伤之间的统计关系。我们对 68 例回顾性招募的急性首发缺血性中风患者进行了病变症状映射。在弥散加权 MRI 扫描中确定病变。使用改良钡吞咽研究损伤特征图谱（MBSImP©™）评估中风后吞咽生理。使用基于体素和基于区域的统计关联测试大脑病变位置与吞咽 17 个生理方面的关系，使用置换阈值的多重比较校正。我们发现，声带抬高、前舌骨运动、声门关闭和咽部残留与病变体素或感兴趣区域有关。所有成分均显示出不同且重叠的病变部位，主要位于右半球，包括皮质区域（额下回、中央前回和后回、缘上回、角回、颞上回、岛叶）、皮质下区域（丘脑、杏仁核）和白质束（上纵束、放射冠、内囊、外囊、连合束、豆状核束）。我们的研究结果表明，中风后吞咽生理的不同方面与不同的病变部位有关，主要位于右半球，主要包括感觉运动整合区域及其相应的白质束。需要进一步的研究来扩展我们的发现，从而支持中风后吞咽生理的神经解剖模型和针对中风后吞咽神经生理基础的治疗方法的发展。
