title: MRI-Based Neuroanatomical Predictors of Dysphagia, Dysarthria, and Aphasia in Patients with First Acute Ischemic Stroke .
abstract: 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.
  
  
  CONCLUSIONS
  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. .
authors.affiliation: Department of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.|Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.|Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Flowers
authors.affiliation: King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: AlHarbi
authors.affiliation: Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Mikulis
authors.affiliation: Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Silver
authors.affiliation: Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.|Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rochon
authors.affiliation: Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.|Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Streiner
authors.affiliation: Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.|Health Care and Outcomes Research, Krembil Neuroscience Research Institute, Toronto, Ontario, Canada.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Martino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016208:Databases, Factual; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004401:Dysarthria / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009864:Ontario; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D062606:Tertiary Care Centers
keywords: Aphasia; Clinical predictors ; Dysarthria; Dysphagia; Ischemic stroke; Magnetic resonance imaging; Rehabilitation