title: Neuroanatomical correlates of tube dependency and impaired oral intake after hemispheric stroke.
abstract: OBJECTIVE
  Acute stroke patients with severely impaired oral intake are at risk of malnutrition and dehydration. Rapid identification of these patients is necessary to establish early enteral tube feeding. Whether specific lesion location predicts early tube dependency was analysed, and the neural correlates of impaired oral intake after hemispheric ischaemic stroke were assessed.
  
  
  METHODS
  Tube dependency and functional oral intake were evaluated with a standardized comprehensive swallowing assessment within the first 48 h after magnetic resonance imaging proven first-time acute supratentorial ischaemic stroke. Voxel-based lesion symptom mapping (VLSM) was performed to compare lesion location between tube-dependent patients versus patients without tube feeding and impaired versus unimpaired oral intake.
  
  
  RESULTS
  Out of 119 included patients 43 (36%) had impaired oral intake and 12 (10%) were tube dependent. Both tube dependency and impaired oral intake were significantly associated with a higher National Institutes of Health Stroke Scale score and larger infarct volume and these patients had worse clinical outcome at discharge. Clinical characteristics did not differ between left and right hemispheric strokes. In the VLSM analysis, mildly impaired oral intake correlated with lesions of the Rolandic operculum, the insular cortex, the superior corona radiata and to a lesser extent of the putamen, the external capsule and the superior longitudinal fascicle. Tube dependency was significantly associated with affection of the anterior insular cortex.
  
  
  CONCLUSIONS
  Mild impairment of oral intake correlates with damage to a widespread operculo-insular swallowing network. However, specific lesions of the anterior insula lead to severe impairment and tube dependency and clinicians might consider early enteral tube feeding in these patients.
authors.affiliation: Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland.|Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Galovic
authors.affiliation: Speech Pathology Service, Department of Otorhinolaryngology, Kantonsspital St Gallen, St Gallen, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Leisi
authors.affiliation: Speech Pathology Service, Department of Otorhinolaryngology, Kantonsspital St Gallen, St Gallen, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Müller
authors.affiliation: Division of Neuroradiology, Department of Radiology, Kantonsspital St Gallen, St Gallen, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Weber
authors.affiliation: Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Tettenborn
authors.affiliation: Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland.|Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Brugger
authors.affiliation: Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland.|Support Centre for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital and University of Bern, Bern, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Abela
authors.affiliation: Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland.|Support Centre for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, University Hospital Inselspital and University of Bern, Bern, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Weder
authors.affiliation: Department of Neurology, Kantonsspital St Gallen, St Gallen, Switzerland.
authors.forename: G
authors.initials: G
authors.lastname: Kägi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D002540:Cerebral Cortex / Q000000981:diagnostic imaging* / Q000473:pathology; D003680:Deglutition Disorders / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D014481:United States
keywords: cohort study; magnetic resonance imaging; rehabilitation; stroke