Hu Xiao, Wang Min, Wang Zijie, Xie Yanfang, Zhang Mengqiu, Zhang Shanyu, Yang Tiannan, Fang Chuanqin, Zhao Libo, Tian Yanghua, Li Qi
Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China.
Ther Adv Neurol Disord. 2025 Jan 18;18:17562864241311130. doi: 10.1177/17562864241311130. eCollection 2025.
Dysphagia is a common complication following intracerebral hemorrhage (ICH) and is associated with an increased risk of aspiration pneumonia and poor outcomes.
This study aimed to explore associated lesion patterns and contributing factors of post-ICH dysphagia, and predict dysphagia outcomes following ICH.
A multicenter, prospective study.
Patients with ICH from two stroke centers within 72 h of symptom onset received baseline bedside swallowing evaluations. Dysphagia-related lesion patterns were identified using support-vector regression-based lesion-symptom mapping. Predictors of swallowing impairment on the 7th and 30th day, as well as stroke-associated pneumonia (SAP), were determined through multiple logistic regression analyses, and nomograms were developed.
A total of 153 patients were included in the final analysis. Of those, 28 had dysphagia. Dysphagia-related lesions predominantly affected bilateral subcortical and adjacent cortical regions. Stroke severity, hematoma expansion, and basal ganglia hemorrhage were significantly associated with initial dysphagia. Baseline aspiration risk and age were identified as independent predictors of impaired swallowing function on days 7 and 30, and SAP. Moreover, ICH volume was significantly correlated with swallowing impairment on day 7 and SAP occurrence. Midline shift and basal ganglia hematoma remained independent predictors of impaired swallowing on day 30. Predictive models for swallowing impairment on days 7 and 30, as well as SAP, demonstrated strong calibration and discriminatory ability, with C indices of 0.867, 0.895, and 0.773, respectively.
Post-ICH dysphagia can be predicted based on stroke severity, hematoma expansion, and basal ganglia hemorrhage. Incorporating aspiration risk and imaging evaluation can further improve the identification of patients at high risk for swallowing impairment at both 1 week and 1 month after ICH.
吞咽困难是脑出血（ICH）后的常见并发症，与吸入性肺炎风险增加及不良预后相关。
本研究旨在探讨脑出血后吞咽困难的相关病变模式及促成因素，并预测脑出血后的吞咽困难结局。
一项多中心前瞻性研究。
症状发作72小时内来自两个卒中中心的脑出血患者接受了基线床边吞咽评估。使用基于支持向量回归的病变-症状映射识别吞咽困难相关病变模式。通过多因素逻辑回归分析确定第7天和第30天吞咽功能障碍以及卒中相关性肺炎（SAP）的预测因素，并绘制列线图。
最终分析纳入了153例患者。其中，28例有吞咽困难。吞咽困难相关病变主要累及双侧皮质下及相邻皮质区域。卒中严重程度、血肿扩大和基底节出血与初始吞咽困难显著相关。基线误吸风险和年龄被确定为第7天和第30天吞咽功能障碍以及SAP的独立预测因素。此外，脑出血体积与第7天吞咽功能障碍及SAP发生显著相关。中线移位和基底节血肿仍是第30天吞咽功能障碍的独立预测因素。第7天和第30天吞咽功能障碍以及SAP的预测模型显示出良好的校准和鉴别能力，C指数分别为0.867、0.895和0.773。
可根据卒中严重程度、血肿扩大和基底节出血预测脑出血后吞咽困难。纳入误吸风险和影像学评估可进一步改善脑出血后1周和1个月时吞咽功能障碍高危患者的识别。
