title: Lesion location predicts transient and extended risk of aspiration after supratentorial ischemic stroke.
abstract: OBJECTIVE
  To assess the association of lesion location and risk of aspiration and to establish predictors of transient versus extended risk of aspiration after supratentorial ischemic stroke.
  
  
  METHODS
  Atlas-based localization analysis was performed in consecutive patients with MRI-proven first-time acute supratentorial ischemic stroke. Standardized swallowing assessment was carried out within 8±18 hours and 7.8±1.2 days after admission.
  
  
  RESULTS
  In a prospective, longitudinal analysis, 34 of 94 patients (36%) were classified as having acute risk of aspiration, which was extended (≥7 days) or transient (<7 days) in 17 cases. There were no between-group differences in age, sex, cause of stroke, risk factors, prestroke disability, lesion side, or the degree of age-related white-matter changes. Correcting for stroke volume and National Institutes of Health Stroke Scale with a multiple logistic regression model, significant adjusted odds ratios in favor of acute risk of aspiration were demonstrated for the internal capsule (adjusted odds ratio, 6.2; P<0.002) and the insular cortex (adjusted odds ratio, 4.8; P<0.003). In a multivariate model of extended versus transient risk of aspiration, combined lesions of the frontal operculum and insular cortex was the only significant independent predictor of poor recovery (adjusted odds ratio, 33.8; P<0.008).
  
  
  CONCLUSIONS
  Lesions of the insular cortex and the internal capsule are significantly associated with acute risk of aspiration after stroke. Combined ischemic infarctions of the frontal operculum and the insular cortex are likely to cause extended risk of aspiration in stroke patients, whereas risk of aspiration tends to be transient in subcortical stroke.
authors.affiliation: From the Department of Neurology (M.G., G.K., B.W.), Speech Pathology Service, Department of Otolaryngology (N.L., M.M.), Division of Neuroradiology, Department of Radiology (J.W.), Kantonsspital St. Gallen, St. Gallen, Switzerland; and Department of Neurology (E.A., B.W.), Support Centre for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology (E.A.), University Hospital Inselspital and University of Bern, Bern, Switzerland.
authors.forename: Marian
authors.initials: M
authors.lastname: Galovic
authors.forename: Natascha
authors.initials: N
authors.lastname: Leisi
authors.forename: Marlise
authors.initials: M
authors.lastname: Müller
authors.forename: Johannes
authors.initials: J
authors.lastname: Weber
authors.forename: Eugenio
authors.initials: E
authors.lastname: Abela
authors.forename: Georg
authors.initials: G
authors.lastname: Kägi
authors.forename: Bruno
authors.initials: B
authors.lastname: Weder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology; D003679:Deglutition; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000209:etiology; D011446:Prospective Studies; D011859:Radiography; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: deglutition disorders; magnetic resonance imaging; stroke