Frequency and predictors of dysphagia in patients with recent small subcortical infarcts

Background and Purpose Detailed data on the occurrence of swallowing dysfunction in patients with recent small subcortical infarcts (RSSI) in the context of cerebral small vessel disease is lacking. This prompted us to assess the frequency of and risk factors for dysphagia in RSSI patients. Methods We identified all inpatients with MRI-confirmed RSSI between January, 2008 and February, 2013. Demographic and clinical data were extracted from our stroke database and MRI scans were reviewed for morphologic changes. Dysphagia was determined according to the Gugging Swallowing Screen. Results We identified 332 patients with RSSI (mean age: 67.7±11.9 years, 64.5% male). Overall, 83 patients (25%) had dysphagia, which was mild in 46 (55.4%), moderate in 26 (31.3%) and severe in 11 patients (13.3%). The rate of dysphagia in patients with supratentorial RSSI was 20%. Multivariate analysis identified a higher NIHSS score (p<0.001), pontine infarction (p<0.01) and more severe white matter hyperintensities (WMH; Fazekas grades 2 and 3, p=0.03) as risk factors for swallowing dysfunction. Conclusions Dysphagia is present in a quarter of patients with RSSI and has to be expected especially in those with higher stroke severity, pontine infarction and severe WMH.