Background and Purpose: About half of the dysphagic stroke patients have persistent swallowing dysfunction after 7 days from symptom onset. The aim of the study was to evaluate incidence, prognosis, clinical and neuroradiological correlates of post-stroke dysphagia. Methods: We prospectively examined consecutive patients with acute ischemic or hemorrhagic stroke. Patients' clinical and neuroradiological data were collected. Swallowing function was assessed by the water swallow test upon admission and after 14 days; patients were then classified as persistent dysphagic, non-persistent dysphagic or non-dysphagic. Results: We recruited 275 patients, 121 of whom were dysphagic upon admission and 254 patients attended follow-up at 14 days; 141 never presented dysphagia, 21 had a non-persistent pattern of dysphagia and 92 had a persistent one. Stroke type, leukoaraiosis degree, previous cognitive impairment and stroke severity upon admission independently predicted the occurrence of dysphagia after stroke and its persistence as well. At receiver operating characteristic (ROC) analysis, the National Institutes of Health Stroke Scale (NIHSS) score of 11.5 was the best predictive value of persistent dysphagia, with a specificity of 90.1% and a sensitivity of 72.4%. Conclusion: Stroke severity is an important predictor of a persistent pattern of dysphagia, with a suggested NIHSS cutoff value of ≥12. An independent correlation was observed with leukoaraiosis and with previous cognitive impairment.

1.
Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R: Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005;36:2756-2763.
2.
Bohannon RW, Smith MB: Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987;67:206-207.
3.
Daniels SK, Anderson JA, Willson PC: Valid items for screening dysphagia risk in patients with stroke: a systematic review. Stroke 2012;43:892-897.
4.
Finlayson O, Kapral M, Hall R, Asllani E, Selchen D, Saposnik G; Canadian Stroke Network; Stroke Outcome Research Canada (SORCan) Working Group: Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke. Neurology 2011;77:1338-1345.
5.
Smithard DG, O'Neill PA, Parks C, Morris J: Complications and outcome after acute stroke. Does dysphagia matter? Stroke 1996;27:1200-1204.
6.
Finestone HM, Greene-Finestone LS: Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional management for stroke patients. CMAJ 2003;169:1041-1044.
7.
Broadley S, Cheek A, Salonikis S, et al: Predicting prolonged dysphagia in acute stroke: the royal adelaide prognostic index for dysphagic stroke (RAPIDS). Dysphagia 2005;20:303-310.
8.
Odderson IR, Keaton JC, McKenna BS: Swallow management in patients on an acute stroke pathway: quality is cost effective. Arch Phys Med Rehabil 1995;76:1130-1133.
9.
Mann G, Hankey GJ, Cameron D: Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999;30:744-748.
10.
Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S; Stroke Practice Improvement Network Investigators: Formal dysphagia screening protocols prevent pneumonia. Stroke 2005;36:1972-1976.
11.
Foley N, Teasell R, Salter K, Kruger E, Martino R: Dysphagia treatment post stroke: a systematic review of randomised controlled trials. Age Ageing 2008;37:258-264.
12.
Edmiaston J, Connor LT, Loehr L, Nassief A: Validation of a dysphagia screening tool in acute stroke patients. Am J Crit Care 2010;19:357-364.
13.
Brott T, Adams HP Jr, Olinger CP, et al: Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20:864-870.
14.
Jorm AF, Jacomb PA: The informant questionnaire on cognitive decline in the elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychol Med 1989;19:1015-1022.
15.
Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA: Mr signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol 1987;149:351-356.
16.
Marik PE, Kaplan D: Aspiration pneumonia and dysphagia in the elderly. Chest 2003;124:328-336.
17.
Hamdy S, Rothwell JC, Aziz Q, Thompson DG: Organization and reorganization of human swallowing motor cortex: implications for recovery after stroke. Clin Sci Lond) 2000;99:151-157.
18.
Paciaroni M, Mazzotta G, Corea F, et al: Dysphagia following stroke. Eur Neurol 2004;51:162-167.
19.
Schroeder MF, Daniels SK, McClain M, Corey DM, Foundas AL: Clinical and cognitive predictors of swallowing recovery in stroke. J Rehabil Res Dev 2006;43:301-310.
20.
Ickenstein GW, Stein J, Ambrosi D, Goldstein R, Horn M, Bogdahn U: Predictors of survival after severe dysphagic stroke. J Neurol 2005;252:1510-1516.
21.
Ertekin C, Aydogdu I, Tarlaci S, Turman AB, Kiylioglu N: Mechanisms of dysphagia in suprabulbar palsy with lacunar infarct. Stroke 2000;31:1370-1376.
22.
LADIS Study Group: 2001-2011: a decade of the LADIS (leukoaraiosis and disability) study: what have we learned about white matter changes and small-vessel disease? Cerebrovasc Dis 2011;32:577-588.
23.
Sellars C, Bowie L, Bagg J, et al: Risk factors for chest infection in acute stroke: a prospective cohort study. Stroke 2007;38:2284-2291.
24.
Adams HP Jr, del Zoppo G, Alberts MJ, et al: Guidelines for the early management of adults with ischemic stroke: a guideline from the American heart association/American stroke association stroke council, clinical cardiology council, cardiovascular radiology and intervention council, and the atherosclerotic peripheral vascular disease and quality of care outcomes in research interdisciplinary working groups: the American academy of neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 2007;38:1655-1711.
25.
Leder SB, Espinosa JF: Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. Dysphagia 2002;17:214-218.
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