Lesion localization in acute stroke patients with risk of aspiration

The objective of this prospective study was to determine whether specific n euroanatomical sites were associated with increased risk of aspiration in a cute stroke patients. Videofluoroscopic swallow studies (VSS) and computed tomography or magnetic resonance imaging scans were completed on consecutiv e male stroke patients (n = 54). Videofluoroscopic swallow studies were sco red on a scale from 0 (normal swallowing) to 4 (severe dysphagia). Patients with scores of 0-1 were grouped together as having no risk of aspiration, and patients with scores of 2-4 were grouped together as having a risk of a spiration. Lesion analyses revealed that location appeared to be more criti cal than hemisphere or lesion size in predicting patients at risk of aspira tion. Anterior locations and subcortical periventricular while matter sites were commonly lesioned in patients with risk of aspiration, whereas patien ts without risk of aspiration were more likely to have posterior lesions an d lesions to subcortical gray matter structures. These data demonstrate tha t swallowing appears to be mediated by a distributed neural network that in volves both cerebral hemispheres with descending input to the medulla; howe ver, specific lesion locations may put patients at. a greater risk of aspir ation.