MRI-Based Neuroanatomical Predictors of Dysphagia, Dysarthria, and Aphasia in Patients with First Acute Ischemic Stroke

Autor: Elizabeth Rochon, David L. Streiner, Heather Flowers, Mohammed A. AlHarbi, Frank L. Silver, David J. Mikulis, Rosemary Martino
Rok vydání: 2017
Předmět:
Male
lcsh:Diseases of the circulatory (Cardiovascular) system
Databases
Factual
Infarction
Brain Ischemia
Tertiary Care Centers
0302 clinical medicine
Risk Factors
Odds Ratio
030212 general & internal medicine
Stroke
Aged
80 and over
Ontario
Ischemic stroke
Rehabilitation
Dysphagia
Middle Aged
Prognosis
Neurology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Lesion
03 medical and health sciences
Magnetic resonance imaging
Atrophy
Predictive Value of Tests
Internal medicine
Aphasia
medicine
Humans
Aged
Retrospective Studies
Clinical predictors
Original Paper
business.industry
Dysarthria
Odds ratio
medicine.disease
Hyperintensity
Deglutition
Logistic Models
lcsh:RC666-701
Multivariate Analysis
Linear Models
Physical therapy
Neurology (clinical)
Deglutition Disorders
business
030217 neurology & neurosurgery
Zdroj: Cerebrovascular Diseases Extra, Vol 7, Iss 1, Pp 21-34 (2017)
Cerebrovascular Diseases Extra
ISSN: 1664-5456
Popis: Background: Due to the high post-stroke frequency of dysphagia, dysarthria, and aphasia, we developed comprehensive neuroanatomical, clinical, and demographic models to predict their presence after acute ischemic stroke. Methods: The sample included 160 randomly selected first-ever stroke patients with confirmed infarction on magnetic resonance imaging from 1 tertiary stroke center. We documented acute lesions within 12 neuroanatomical regions and their associated volumes. Further, we identified concomitant chronic brain disease, including atrophy, white matter hyperintensities, and covert strokes. We developed predictive models using logistic regression with odds ratios (OR) and their 95% confidence intervals (95% CI) including demographic, clinical, and acute and chronic neuroanatomical factors. Results: Predictors of dysphagia included medullary (OR 6.2, 95% CI 1.5–25.8), insular (OR 4.8, 95% CI 2.0–11.8), and pontine (OR 3.6, 95% CI 1.2–10.1) lesions, followed by brain atrophy (OR 3.0, 95% CI 1.04–8.6), internal capsular lesions (OR 2.9, 95% CI 1.2–6.6), and increasing age (OR 1.4, 95% CI 1.1–1.8). Predictors of dysarthria included pontine (OR 7.8, 95% CI 2.7–22.9), insular (OR 4.5, 95% CI 1.8–11.4), and internal capsular (OR 3.6, 95% CI 1.6–7.9) lesions. Predictors of aphasia included left hemisphere insular (OR 34.4, 95% CI 4.2–283.4), thalamic (OR 6.2, 95% CI 1.6–24.4), and cortical middle cerebral artery (OR 4.7, 95% CI 1.5–14.2) lesions. Conclusion: Predicting outcomes following acute stroke is important for treatment decisions. Determining the risk of major post-stroke impairments requires consideration of factors beyond lesion localization. Accordingly, we demonstrated interactions between localized and global brain function for dysphagia and elucidated common lesion locations across 3 debilitating impairments.
Databáze: OpenAIRE
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