The Incidence, Co-occurrence, and Predictors of Dysphagia, Dysarthria, and Aphasia after Acute Ischemic Stroke

Background- Dysphagia, dysarthria and aphasia are frequent sequelae of stroke. We sought to identify their frequency, co-occurrence, and predictors of them after acute ischemic stroke. Methods- First, we used the Registry of the Canadian Stroke Network’s (RCSN) database (2003–2008) from one stroke centre to identify a random sample of 250 patients with acute ischemic stroke confirmed by magnetic resonance imaging (MRI). We conducted a medical chart review to derive frequency estimates for the presence of dysphagia, dysarthria and aphasia and identified clinical predictors of them from the RCSN database. Second, we conducted a systematic review to identify neuroanatomical predictors of dysphagia after acute ischemic stroke. We searched 14 databases, 17 journals, three conference proceedings and the grey literature using the Cochrance Stroke Group search strategy. We pooled individual level data for the dysphagia outcome, calculating relative risks according to neuroanatomical lesion sites. Finally, from the medical chart review, we evaluated MRI scans for patients with acute lesions within 14 days of stroke onset, deriving clinical and neuroanatomical predictors of the three impairments, using logistic regression. Results – First, incidence estimates for dysphagia, dysarthria, and aphasia were 44% (95% CI, 38-51), 42% (95% CI, 35-48) and 30% (95% CI, 25-37), respectively. The highest clinical predictors were non-alert level of consciousness for dysphagia (OR 2.6, CI 1.03-6.5), symptoms of weakness for dysarthria (OR 5.3, CI 2.4-12.0), and right-sided symptoms for aphasia (OR 7.1, CI 3.1-16.6). Second, for our systematic review, we reviewed 964 abstracts, accepting 84 for full review. Seventeen met our inclusion criteria, providing individual results for 656 patients. Predictors of dysphagia included pontine (RR 3.7, 95% CI 1.5-7.7), medial medullary (RR 6.9, 95% CI 3.4-10.9) and lateral medullary (RR 9.6, 95% CI 5.9-12.8) lesions. Finally, 160 patients met our eligibility criteria for MRI analysis. Strongest predictors included medullary lesions (OR 6.2, 95% CI 1.5 – 25.8) for dysphagia, pontine lesions (OR 7.8, 95% CI 2.7 – 22.9) for dysarthria, and insular lesions (OR 34.4, 95% CI 4.2 – 283.4) for aphasia. Conclusions- We computed the frequency of dysphagia, dysarthria, and aphasia, identifying clinical and whole brain neuroanatomical predictors of their presence.

Department dc:contributor.department

Speech-Language Pathology

Year dc:date.issued

2014

Author dc:creator

• Flowers, Heather

Advisor dc:contributor.advisor

• Martino, Rosemary

• stroke
• MRI
• dysphagia
• dysarthria
• aphasia

Statement dc:rights

• Attribution-NoDerivs 2.5 Canada

Licence dc:rights.uri

• http://creativecommons.org/licenses/by-nd/2.5/ca/

Language dc:language.iso

en_ca

Handle dc:identifier.uri

http://hdl.handle.net/1807/72503

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/72503