Clinical and imaging predictors of dysphagia and swallowing ability recovery in acute ischemic stroke

Objective Dysphagia is one of the most common complications of acute ischemic stroke, and prediction of dysphagia is crucial for post-stroke treatment. We aimed to identify predictors of dysphagia and swallowing function recovery following ischemic stroke and to investigate dysphagia-associated lesion location. Methods We prospectively enrolled patients with acute ischemic stroke confirmed on diffusion-weighted imaging. All patients received swallowing evaluation within 48 h after admission. Follow-up oral intake ability was measured on 7 and 30 days after stroke onset. Voxel-based lesion-symptom mapping was performed to determine locations associated with dysphagia. Results Of 126 patients included in the final analysis, 23 patients (18.3%) were classified as initial dysphagia. The presence of facial palsy ( P = 0.008) and larger white matter hyperintensity (WMH) volume ( P = 0.003) was associated with initial dysphagia. Initial risk of aspiration assessed by Any2 score ( P = 0.001) at baseline was identified as independent predictor for dysphagia at day 7. Patients with higher Any2 score ( P < 0.001), aphasia ( P = 0.013), and larger WMH volume ( P = 0.010) were less likely to have a full swallowing function recovery at 1 month. Acute infarcts in right corona radiata and right superior longitudinal fasciculus were correlated with impaired recovery of swallowing ability at 1 month. Conclusions Initial risk of aspiration was identified as risk factor for short-term and long-term dysphagia. Aphasia and larger WMH volume were revealed to be significant predictors for swallowing function recovery at 1 month. Right corona radiata was identified as an essential brain area for dysphagia.