THE NATURAL-HISTORY OF DYSPHAGIA FOLLOWING A STROKE

To assess the frequency and natural history of swallowing problems fol lowing an acute stroke, 121 consecutive patients admitted within 24 ho urs of the onset of their stroke were studied prospectively. The abili ty to swallow was assessed repeatedly by a physician, a speech and lan guage therapist, and by videofluoroscopy. Clinically 51% (61/121) of p atients were assessed as being at risk of aspiration on admission. Man y swallowing problems resolved over the first 7 days, through 28/110 ( 27%) were still considered at risk by the physician. Over a 6-month pe riod, most problems had resolved, but some patients had persistent dif ficulties (6, 8%), and a few (2, 3% at 6 months) had developed swallow ing problems. Ninety-five patients underwent videofluoroscopic examina tion within a median time of 2 days; 21 (22%) were aspirating. At 1 mo nth a repeat examination showed that 12 (15%) were aspirating. Only 4 of these were persistent; the remaining 8 had not been previously iden tified. This study has confirmed that swallowing problems following ac ute stroke are common, and it has been documented that the dysphagia m ay persist, recur in some patients, or develop in others later in the history of their stroke.