The Relationship Between Leukoaraiosis Involving Contralateral Corticobulbar Tract and Dysphagia in Patients with Acute Unilateral Corona Radiata Infarction with Corticobulbar Tract Involvement

Abstract

This study investigated the impact of leukoaraiosis (LA) involving the contralateral corticobulbar tract (CBT) on dysphagia in patients with unilateral corona radiata (CR) infarction with CBT involvement. Patients admitted to the Department of Neurology (September 2011-August 2014) were evaluated; those with a first episode of acute unilateral CR infarction involving the CBT and with LA were included. The 'Case' group comprised patients with LA involving the contralateral CBT; the 'Control' group comprised patients with LA not involving the contralateral CBT. The primary outcome was the feeding method at discharge; secondary outcomes were the feeding method at admission and results of the bedside swallowing test, videofluoroscopic swallowing study (VFSS), videofluoroscopic dysphagia scale, penetration-aspiration scale, American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale (ASHA NOMS), oral transit time, and pharyngeal transit time. Infarct size was measured using brain magnetic resonance imaging; LA severity was rated using the Fazekas scale. Eighty-one patients were included (mean age 64.6 ± 11.5 years; 64% male; Case group: 20, 5 underwent VFSS; Control group: 67, 11 underwent VFSS). The Case group was older and had higher total Fazekas scale score than the Control group. The feeding method at discharge and ASHA NOMS score were significantly worse in the Case group than in the Control group. Multivariate analysis revealed that LA involving the contralateral CBT independently predicted the feeding method at discharge and ASHA NOMS score. In conclusion, LA involving the contralateral CBT is associated with dysphagia in patients with unilateral CR infarction involving the CBT.

Keywords: Deglutition disorders; Infarction; Leukoaraiosis; Neuroimaging; Pyramidal tracts.