Stroke Localization and the Development of Post-Stroke Dysphagia
The main goal of this research is to describe the brain injury patterns associated with dysphagia after stroke as well as brain injury patterns in patients with persistent dysphagia after the acute phase. We hypothesize that there are specific areas of the brain that, if affected, will result in persistent dysphagia.
Specifically we want to determine:
- Whether strokes in specific anatomic locations are associated with increased risk of dysphagia. Our working hypothesis is that patients with strokes affecting the sensorimortor cortex, insular and/or cerebellar swallowing areas will be more likely to experience swallowing dysfunction after a stroke.
- If the size of the stroke is associated with increased incidence of dysphagia. Our working hypothesis is that large strokes are more likely to permanently interrupt the cortico-bulbar pathways and the coordination between the multiple areas of the brain involved in swallowing.
- If early recovery of swallowing function after a stroke is associated with improved perfusion of the surrounding non-infarcted tissue. We hypothesize that the early recovery in some patients can be explained by the improved perfusion of the brain areas surrounding the stroke thus reducing the amount of dysfunctional brain tissue. The difference between the volume of dysfunctional tissue and the volume of infracted tissue at stroke onset of patients whose dysphagia resolved within the acute period post stroke will be compared to those who remained dysphagic beyond the acute post stroke phase.
Clearly defining the association between stroke size and location in stroke patients that develop dysphagia would allow clinicians to identify patients with potential dysphagic complications earlier. It would also permit identification of patients that are unlikely to improve, preventing additional complications, and allowing for the benefit from early placement of gastrostomy tubes for alimentation. Ultimately this work will be a step towards developing an evidence-based algorithm for the treatment of dysphagia after stroke depending on the underlying brain deficit.
