Predictors of Prolonged Dysphagia Following Acute Stroke

Abstract

Background Dysphagia typically refers to difficulty in eating as a result of disruption in the swallowing process. Dysphagia can be a serious threat to one's health because of the risk of aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction (Han et al., 2008). Stroke is the leading cause of neurologic dysphagia. Approximately 51-73% of patients with stroke have dysphagia, which is the most significant risk factor for the development of pneumonia. This can also delay the patient's functional recovery (Bussell et al., 2011). The early identification of those at risk of significant dysphagia and requiring nutritional support will permit the study of early nutritional supplementation via nasoenteric tubes (NET) or percutaneous gastrostomy (PEG). Aim of the work The aim of this study is to identify predictors of prolonged dysphagia following acute stroke and proper management of similar cases.

Subjects and Methods This study was a prospective cohort study conducted on 113 patients with acute stroke admitted within 24 hours to stroke unit at Ain shams specialized hospital over 1 year were subjected to detailed clinical assessment, structural brain imaging using MRI and Particular attention had been considered to bulbar function, with dysarthria and voluntary cough and pharyngeal sensation had been notedand subsequent progress was recorded. Subjects were divided into 3 groups for analysis: no dysphagia; transient dysphagia (≤14 days); or prolonged dysphagia (>14 days). Particular attention was paid to bulbar function. Stroke severity was assessed using the National Institutes of Health Stroke Scale on admission and on discharge. The water swallow test was performed to all patients who were able to attend sufficiently to follow the instructions. Modified Barium Swallow or Video-fluoroscopy test was done for some patients to detect the oropharyngeal dysphagia.