Department of Neurology, Medical Faculty Mannheim, Mannheim Center for Translational Neuroscience (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Dysphagia. 2024 Apr;39(2):289-298. doi: 10.1007/s00455-023-10611-z. Epub 2023 Aug 3.
Post-stroke dysphagia (PSD) is a severe and common complication after ischemic stroke. The role of silent aspiration as an important contributing factor in the development of a dysphagia-associated complications, in particular aspiration-associated pneumonia has been insufficiently understood. The aim of this study was to investigate the characteristics and risk factors of silent aspiration in patients with acute infratentorial stroke by FEES and to identify culprit lesions in stroke patient with a high risk of silent aspiration via voxel-based-symptom-lesion mapping (VBS/ML). This study is a retrospective observational study based on a prospectively collected FEES and stroke database. Consecutive patient cases with acute ischemic infratentorial stroke and FEES examination between 2017 and 2022 were identified. Group allocation was performed based on PAS scores. Imaging analysis was performed by manual assignment and by VBS/ML. Group comparisons were performed to assess silent aspiration characteristics. Binary logistic regression analysis was performed to determine if baseline clinical, demographic, and imaging parameters were helpful in predicting silent aspiration in patients. In this study 84 patient cases with acute infratentorial stroke who underwent FEES examination were included. Patients were moderately affected at admission (mean NIH-SS score at admission 5.7 SD ± 4.7). Most lesions were found pontine. Overall 40.5% of patients suffered from silent aspiration, most frequently in case of bilateral lesions. Patients with silent aspiration had higher NIH-SS scores at admission (p < 0.05), had a more severe swallowing disorder (p < 0.05) and were 4.7 times more likely to develop post-stroke pneumonia. Patients who underwent FEES examination later than 72 h after symptom onset were significantly more likely to suffer from silent aspiration and to develop pneumonia compared to patients who underwent FEES examination within the first 72 h (p < 0.05). A binary logistic regression model identified NIH-SS at admission as a weak predictor of silent aspiration. Neither in manual assignment of the lesions to brain regions nor in voxel-wise statistic regression any specific region was useful in prediction of silent aspiration. Silent aspiration is common in patients with infratentorial stroke and contributes to the risk for pneumonia. Patients with silent aspiration are more severely affected by stroke, but cannot reliably be identified by NIH-SS at admission or lesion location. Patients suffering from acute infratentorial stroke should been screened and examined for PSD and silent aspiration.
脑梗死后吞咽困难（PSD）是缺血性脑卒中后的一种严重且常见的并发症。作为吞咽困难相关并发症发展的一个重要促成因素，无声吸入的作用，特别是与吸入相关的肺炎，尚未得到充分理解。本研究旨在通过纤维内镜吞咽功能检查（FEES）研究急性小脑梗死患者无声吸入的特征和危险因素，并通过基于体素的症状-病变映射（VBS/ML）识别有发生无声吸入高风险的卒中患者的责任病灶。本研究是一项基于前瞻性收集的 FEES 和卒中数据库的回顾性观察性研究。连续入选 2017 年至 2022 年期间患有急性缺血性小脑梗死和 FEES 检查的患者。根据 PAS 评分进行分组。通过手动分配和 VBS/ML 进行影像学分析。进行组间比较以评估无声吸入的特征。采用二元逻辑回归分析确定基线临床、人口统计学和影像学参数是否有助于预测患者的无声吸入。本研究共纳入 84 例急性小脑梗死患者行 FEES 检查。患者入院时中度受影响（入院时平均 NIH-SS 评分 5.7±4.7）。大多数病变位于桥脑。总的来说，40.5%的患者存在无声吸入，双侧病变时最常见。有无声吸入的患者入院时 NIH-SS 评分较高（p<0.05），吞咽障碍更严重（p<0.05），发生卒中后肺炎的可能性增加 4.7 倍。症状发作后 72 小时内行 FEES 检查的患者与 72 小时内行 FEES 检查的患者相比，更有可能发生无声吸入和肺炎（p<0.05）。二元逻辑回归模型将入院时的 NIH-SS 确定为无声吸入的弱预测因子。在手动将病变分配到脑区或基于体素的统计回归中，任何特定区域都不能用于预测无声吸入。小脑梗死患者无声吸入较为常见，与肺炎风险相关。有无声吸入的患者卒中更严重，但不能通过入院时 NIH-SS 或病变位置可靠地识别。患有急性小脑梗死的患者应进行筛查和检查 PSD 和无声吸入。
