Which cortical area is related to the development of dysphagia after stroke? A single photon emission computed tomography study using novel analytic methods

Momosaki R; Abo M; Kakuda W; Uruma G

Eur Neurol;67(2):74-80, 2012.

PURPOSE: The purpose of this study is to clarify cortical areas related to the development of dysphagia in poststroke patients using novel analytic methods for single photon emission computed tomography (SPECT) imaging. SUBJECTS AND METHODS: Twenty poststroke patients (age: 66.1 ± 5.1 years) with a left hemispheric lesion were studied. According to clinical evaluation, patients were divided into a dysphagia group (n = 10) and a control group (n = 10). In each patient, measurement of regional cerebral blood flow (rCBF) was performed by SPECT imaging with a 99mTc-ethylcysteinate dimer. For the analysis, an easy Z-score imaging system and voxel-based stereotactic extraction estimation were applied, with placing regions of interest segmented into the Brodmann area level. We compared rCBF in each area between the two groups, and receiver operating characteristic analysis to calculate the area under the curve was also performed. RESULTS: The rCBF in Brodmann areas 4 and 24 was significantly lower in the dysphagia group. The highest area under the curve was found in Brodmann area 4. In this area, 80% sensitivity and 60% specificity for discriminating dysphagia were achieved with an optimal cutoff value. CONCLUSIONS: When analyzed with novel methods, SPECT imaging can be useful for predicting the risk of dysphagia and subsequent aspiration in poststroke patients.

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Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência

Schelp, Arthur Oscar; Cola, Paula Cristina; Gatto, Ana Rita; Silva, Roberta Gonçalves da; Carvalho, Lídia Raquel de
Arq. Neuro-Psiquiatr. 62(2b): 503-506, GRA. 2004 Jun.

RESUMO

A doença vascular encefálica (AVE) é a principal causa de morte no Brasil. As seqüelas em indivíduos pós-acidente vascular encefálico incluem distúrbios motores, distúrbios de fala ou de linguagem e distúrbios de deglutição. A disfagia orofaríngea ocorre em cerca de 50% dos pacientes com AVE. Este estudo teve por objetivo determinar a incidência da disfagia após AVE. Foram avaliados todos os pacientes que deram entrada em hospital universitário de referência no período de um ano, tão logo apresentassem condições para avaliação clínica, fonoaudiológica e neurológica (102 pacientes), com análise objetiva da deglutição (61 pacientes). Foi observada incidência de disfagia em 76,5% dos pacientes avaliados clinicamente, este percentual elevando-se a 91% com avaliação videofluoroscópica. A alta incidência de disfagia observada neste estudo que avaliou pacientes com amplo espectro de gravidade, em diferentes fases de recuperação, ressalta a importância de equipe multidisciplinar, incluindo fonoaudiólogos capacitados, para avaliar os distúrbios da deglutição nos diversos momentos de recuperação dos AVEs.

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