title: Diverging lesion and connectivity patterns influence early and late swallowing recovery after hemispheric stroke.
abstract: Knowledge about the recovery of oral intake after hemispheric stroke is important to guide therapeutic decisions, including the administration of enteral tube feeding and the choice of the appropriate feeding route. They aimed to determine the localization and connectivity of lesions in impaired recovery versus recovered swallowing after initially dysphagic stroke. Sixty-two acute ischemic hemispheric stroke patients with impaired oral intake were included in a prospective observational cohort study. Voxel-based lesion-symptom mapping and probabilistic tractography were used to determine the association of lesion location and connectivity with impaired recovery of oral intake ≥7 days (indication for early tube feeding) and ≥4 weeks (indication for percutaneous endoscopic gastrostomy feeding) after stroke. Two distinct patterns influencing recovery of swallowing were recognized. Firstly, impaired recovery of oral intake after ≥7 days was significantly associated with lesions of the superior corona radiata (65% of statistical map, P < 0.05). The affected fibers were connected with the thalamus, primary motor, and supplemental motor areas and the basal ganglia. Secondly, impaired recovery of oral intake after ≥4 weeks significantly correlated with lesions of the anterior insula (54% of statistical map, P < 0.05), which was connected to adjacent operculo-insular areas of deglutition. These findings indicate that early swallowing recovery is influenced by white matter lesions disrupting thalamic and corticobulbar projection fibers. Late recovery is determined by specific cortical lesions affecting association fibers. This knowledge may help clinicians to identify patients at risk of prolonged swallowing problems that would benefit from enteral tube feeding. Hum Brain Mapp 38:2165-2176, 2017. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.|Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, UK National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, WC1N 3BG.|Epilepsy Society, Chalfont St. Peter, SL9 0RJ, United Kingdom.
authors.forename: Marian
authors.identifier: 0000-0002-2307-071X
authors.initials: M
authors.lastname: Galovic
authors.affiliation: Department of Otorhinolaryngology, Speech Pathology Service, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Natascha
authors.initials: N
authors.lastname: Leisi
authors.affiliation: Support Centre for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, University of Bern, Bern, Switzerland.|Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland.
authors.forename: Manuela
authors.initials: M
authors.lastname: Pastore-Wapp
authors.affiliation: Support Centre for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Zbinden
authors.affiliation: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, UK National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, WC1N 3BG.|Epilepsy Society, Chalfont St. Peter, SL9 0RJ, United Kingdom.|Translational Imaging Group, Centre for Medical Image Computing, University College London, London, United Kingdom.
authors.forename: Sjoerd B
authors.initials: SB
authors.lastname: Vos
authors.affiliation: Department of Otorhinolaryngology, Speech Pathology Service, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Marlise
authors.initials: M
authors.lastname: Mueller
authors.affiliation: Division of Neuroradiology, Department of Radiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Weber
authors.affiliation: Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Brugger
authors.affiliation: Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Kägi
authors.affiliation: Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.|Support Centre for Advanced Neuroimaging (SCAN), Institute of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital, University of Bern, Bern, Switzerland.
authors.forename: Bruno J
authors.initials: BJ
authors.lastname: Weder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D001931:Brain Mapping; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D056324:Diffusion Tensor Imaging; D001068:Feeding and Eating Disorders / Q000209:etiology; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000000981:diagnostic imaging / Q000503:physiopathology; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology
keywords: deglutition disorders; dysphagia; magnetic resonance imaging; rehabilitation; stroke