Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea.
Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea.
Int J Stroke. 2022 Feb;17(2):207-217. doi: 10.1177/17474930211006300. Epub 2021 Apr 12.
Poststroke cricopharyngeal dysfunction has been reported to occur in 50% of brainstem strokes; however, cricopharyngeal dysfunction also occurs commonly in patients with supratentorial stroke. The hemispheric neuroanatomical location of this dysfunction has not been clearly identified.
We aimed to analyze the relationship between cricopharyngeal dysfunction and supratentorial lesion location in poststroke patients through this retrospective case-control voxel-based lesion-symptom mapping study.
Cricopharyngeal dysfunction was diagnosed when the residue after swallowing (pyriform sinus) accounted for more than 25% of volume of pyriform sinus. Medical records and the video fluoroscopic swallowing studies of first-ever stroke patients who were admitted to our hospital during acute to subacute phase from 2009 to 2019 were reviewed. After propensity score matching to reduce the likelihood of selection bias, 50 patients per group were included in the cricopharyngeal dysfunction and control groups. We used a threshold of 0.01 corrected for multiple comparisons with permutation thresholding (5000 permutations). Dichotomized diagnosis of cricopharyngeal dysfunction and the magnitude of pyriform sinus were used as dependent variables.
Analysis using the Liebermeister statistics indicated that lesions of the right lentiform nucleus were associated with the development of cricopharyngeal dysfunction. After adjustment for age and total lesion volume, which are known effectors for the development of dysphagia, statistically significant correlations were found between pyriform sinus and lesions of the right lentiform nucleus and anterior corona radiata beneath the right middle frontal gyrus.
Thus, our study demonstrated for the first time that damages to the right lentiform nucleus, especially globus pallidus externa, and anterior corona radiata beneath the right middle frontal gyrus are associated with the development and severity of cricopharyngeal dysfunction.
据报道，脑桥卒中患者中有 50%发生卒中后环咽肌功能障碍，但大脑半球卒中患者也常发生环咽肌功能障碍。这种功能障碍的半球神经解剖位置尚未明确。
通过回顾性病例对照基于体素的病变-症状映射研究，分析卒中后环咽肌功能障碍与大脑半球病变部位的关系。
吞咽后残留（梨状隐窝）占梨状隐窝体积的 25%以上时，诊断为环咽肌功能障碍。回顾性分析 2009 年至 2019 年急性至亚急性期间我院收治的首次卒中患者的病历和视频荧光透视吞咽研究。通过倾向评分匹配以降低选择偏倚的可能性，每组纳入 50 名患者，分别纳入环咽肌功能障碍组和对照组。我们使用 Liebermeister 统计分析，以 0.01 为阈值校正多重比较和置换阈值（5000 次置换）。二分类诊断的环咽肌功能障碍和梨状隐窝大小作为因变量。
Liebermeister 统计分析表明，右侧豆状核病变与环咽肌功能障碍的发生有关。在校正已知吞咽困难发生的效应器年龄和总病变体积后，仍发现梨状隐窝与右侧豆状核和右额中回下的前放射冠之间存在显著相关性。
因此，我们的研究首次表明，右侧豆状核，特别是外苍白球和右额中回下的前放射冠的损伤与环咽肌功能障碍的发生和严重程度有关。
