From the Guidelines
A patient with an ischemic stroke in the medial right cerebral artery is likely to develop dysphagia due to damage to brain regions controlling swallowing function, emphasizing the need for early dysphagia screening and management to prevent complications such as aspiration pneumonia, malnutrition, and dehydration. The middle cerebral artery supplies blood to important areas involved in the voluntary phases of swallowing, including parts of the primary motor and sensory cortices, insula, and internal capsule. When blood flow is interrupted to these areas, it can impair the coordination of muscles involved in swallowing, as noted in guidelines for adult stroke rehabilitation and recovery 1. Although swallowing is typically represented bilaterally in the brain, unilateral strokes can still cause dysphagia due to the complex neural network involved. The right hemisphere specifically contributes to pharyngeal transit time and esophageal clearance, and damage here can disrupt these processes.
Some key points to consider in the management of dysphagia in stroke patients include:
- Early dysphagia screening is recommended for acute stroke patients to identify dysphagia or aspiration, which can lead to pneumonia, malnutrition, dehydration, and other complications 1.
- Assessment of swallowing before the patient begins eating, drinking, or receiving oral medications is recommended, and an instrumental evaluation is probably indicated for those patients suspected of aspiration 1.
- Management typically involves dietary modifications (thickened liquids, pureed foods), swallowing therapy with a speech-language pathologist, and in severe cases, consideration of alternative feeding methods like nasogastric tubes until swallowing function improves.
- Oral hygiene protocols should be implemented to reduce the risk of aspiration pneumonia after stroke, and enteral feedings (tube feedings) should be initiated within 7 days after stroke for patients who cannot safely swallow 1.
It is essential to prioritize early intervention and management of dysphagia in stroke patients, as dysphagia has been associated with poorer ability to complete activities of daily living (ADLs), greater caregiver burden, and more frequent nursing home placement, as well as increased risk of aspiration pneumonia, which leads to higher mortality rates 1. Therefore, prompt evaluation and treatment of dysphagia are critical in the rehabilitation of patients with ischemic stroke to improve outcomes and quality of life.
From the Research
Dysphagia in Ischemic Stroke
- Dysphagia is a common complication of acute ischemic stroke, and its prediction is crucial for post-stroke treatment 2.
- The presence of facial palsy, larger white matter hyperintensity volume, and initial risk of aspiration are associated with dysphagia in patients with acute ischemic stroke 2.
- Acute infarcts in the right corona radiata and right superior longitudinal fasciculus are correlated with impaired recovery of swallowing ability at 1 month 2.
Brain Regions Associated with Dysphagia
- The right corona radiata has been identified as an essential brain area for dysphagia 2.
- Other supratentorial areas that may be associated with dysphagia include the primary somatosensory, motor, and motor supplementary areas, orbitofrontal cortex, putamen, caudate, basal ganglia, and internal capsule 3.
- The left inferior parietal gyrus has also been identified as a key brain region for post-stroke dysphagia 4.
Stroke Localization and Dysphagia
- The severity and progression of dysphagia in patients with ischemic stroke can be influenced by stroke localization, with severe dysphagia being more common among patients with right hemisphere strokes 5.
- Early rehabilitation has been shown to be effective in improving swallowing in patients with right hemisphere strokes 5.
- The medial right cerebral artery (MCA) is not specifically mentioned in the studies as a common location for dysphagia, but the right corona radiata, which is supplied by the MCA, has been associated with dysphagia 2.