Medical University of South Carolina, SC, USA.
University of South Carolina, SC, USA.
Neuroimage Clin. 2024;44:103710. doi: 10.1016/j.nicl.2024.103710. Epub 2024 Nov 20.
The high incidence of dysphagia after acute stroke is likely the result of cumulative effects of the stroke and pre-stroke brain health. While cerebral small vessel disease (cSVD) is recognized as a marker of compromised brain health, it's unclear which neuroanatomical pathologies of cSVD impact post-stroke dysphagia. We assessed the relation between cSVD pathologies, i.e., brain atrophy, white matter hyperintensities (WMH), perivascular spaces, as markers for brain integrity at the time of the stroke, and acute post-stroke dysphagia measured with the Modified Barium Swallow Study (MBSS).
We conducted a retrospective, observational study of 40 individuals with an acute first-ever ischemic stroke. We segmented T1-weighted images into gray matter, white matter, and cerebrospinal fluid (CSF) to derive brain atrophy estimates. We scored the presence and severity of periventricular and deep WMH using the Fazekas scale and counted perivascular spaces in the basal ganglia following standard guidelines. Swallow impairments were determined with the Modified Barium Swallow Impairment Profile (MBSImP), Penetration-Aspiration Scale, and timing measures (oral (OTT), and pharyngeal transit times (PTT)). We performed regression to assess the relation between cSVD pathologies and swallowing while controlling for the stroke overlap with the right and left corticobulbar tracts, stroke volume, and the number of days between the MRI and MBSS.
Worse brain atrophy and more severe periventricular WMH were related to more severe MBSImP pharyngeal total scores, and worse deep WMH were related to aspiration events. More severe perivascular spaces in the basal ganglia were related to longer OTT and PTT, with a high explanatory value (27.5% and 25.1%, respectively), even when controlling for chronological age.
Our results suggest that several aspects of pre-stroke brain health impact dysphagia severity after acute stroke independent of the stroke site and size. These findings contribute to our understanding of mechanisms underlying the variability of post-stroke dysphagia and emphasize the importance of brain structural integrity before the stroke. Future larger studies are warranted.
急性中风后吞咽困难的高发病率可能是中风和中风前大脑健康累积效应的结果。虽然脑小血管疾病 (cSVD) 被认为是大脑健康受损的标志物，但尚不清楚 cSVD 的哪些神经解剖病理学影响中风后吞咽困难。我们评估了 cSVD 病理与中风时大脑完整性的标记物（即脑萎缩、脑白质高信号 (WMH)、血管周围间隙）之间的关系，以及使用改良钡吞咽研究 (MBSS) 测量的急性中风后吞咽困难。
我们对 40 名首次急性缺血性中风患者进行了回顾性观察性研究。我们将 T1 加权图像分割为灰质、白质和脑脊液 (CSF)，以得出脑萎缩估计值。我们使用 Fazekas 量表对脑室周围和深部 WMH 的存在和严重程度进行评分，并按照标准指南在基底节计数血管周围间隙。吞咽障碍通过改良钡吞咽障碍概况 (MBSImP)、渗透-吸入量表和时间测量（口腔 (OTT) 和咽通过时间 (PTT)）确定。我们进行回归分析，以评估 cSVD 病理与吞咽之间的关系，同时控制 MRI 和 MBSS 之间的天数、中风重叠与左右皮质延髓束、中风体积。
更严重的脑萎缩和更严重的脑室周围 WMH 与更严重的 MBSImP 咽部总分相关，更严重的深部 WMH 与吸入事件相关。基底节区更严重的血管周围间隙与 OTT 和 PTT 较长有关，具有较高的解释力（分别为 27.5%和 25.1%），即使在控制年龄的情况下也是如此。
我们的结果表明，中风前大脑健康的几个方面独立于中风部位和大小影响中风后吞咽困难的严重程度。这些发现有助于我们了解中风后吞咽困难变异性的机制，并强调中风前大脑结构完整性的重要性。需要进行更大的未来研究。
