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The Impact of Periventricular Leukoaraiosis in Post-stroke Oropharyngeal Dysphagia: A Swallowing Biomechanics and MRI-Based Study

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Abstract

Oropharyngeal dysphagia is a highly prevalent post-stroke complication commonly associated with topographically specific gray-matter damage. In contrast, the role of damage to the extensive white matter brain network (leukoaraiosis) in post-stroke oropharyngeal dysphagia has not yet been clarified. We aim to assess the role of leukoaraiosis in post-stroke oropharyngeal dysphagia. We designed a cross-sectional study and retrospectively collected from our database patients with dysphagia affected by a recent stroke and on whom both a brain 1.5 T-MRI and a videofluoroscopy had been performed. Leukoaraiosis was assessed in brainstem and in cerebral regions (periventricular or deep) with Fazekas scale. Penetration-Aspiration-Scale and time to laryngeal vestibule closure and to upper esophageal sphincter opening were analyzed. Study population (n = 121; 57% men, 75.5 ± 9.4y) presented mostly supratentorial ischemic PACI-type strokes. Of the patients, 86% had unsafe swallows (PAS = 3.97 ± 2.04); 94.2% had cerebral leukoaraiosis (Fazekas = 3.36 ± 1.7) and 42.1% had brainstem-leukoaraiosis, hypertension being the main risk factor. We found both significant positive associations between degree of periventricular-leukoaraiosis and total-leukoaraiosis and presence of risk of aspirations (p = 0.016 and p = 0.023, respectively); and a correlation between periventricular-leukoaraiosis and PAS scale severity (r = 0.179, p = 0.049). No correlations/associations were found between stroke volume and dysphagia in this study. Our study supports a role for leukoaraiosis in the pathophysiology of dysphagia. Stroke is associated with chronic short-connection/circuit injury and damage to periventricular white matter long connections is a relevant neuro-pathophysiological mechanism contributing to impaired safety of swallow in post-stroke oropharyngeal dysphagia patients.

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Acknowledgements

Assistance with data collection received from Laura Bonamusa, statistical help received from Elisabet Palomeras and Jane Lewis for English editing assistance.

Funding

This study was supported by research grants from: Investigación Clínica Independiente, Instituto de Salud Carlos III (ICI20/00117); CIBERehd, Acción Estratégica en Disfagia, Instituto de Salud Carlos III (EHD20PI02); Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III (PI18/00241); and The Territorial Competitiveness Specialization Project (PECT) of Mataro-Maresme (PRE/161/2019) financed by the Government of Catalunya-Generalitat de Catalunya within the framework of the European Regional Developments Funds of Catalonia Operational Programme 2014–2020.

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Author notes

  1. Nicolau Guanyabens and Christopher Cabib have contributed equally to this work.

Authors and Affiliations

  1. Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autònoma de Barcelona), Carretera de Cirera 230, 08304, Mataró, Spain

    Nicolau Guanyabens, Christopher Cabib, Viridiana Arreola, Weslania Nascimento, Pere Clavé & Omar Ortega

  2. Neurology Unit, Hospital de Mataró, Carretera de Cirera 230, 08304, Mataró, Spain

    Nicolau Guanyabens & Ernest Palomeras

  3. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain

    Christopher Cabib, Pere Clavé & Omar Ortega

  4. Neuroradiology Unit, Department of Radiology, Hospital de Mataró, Carretera de Cirera 230, 08304, Mataró, Spain

    Anna Ungueti, Montserrat Duh & María Teresa Fernández

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  1. Nicolau Guanyabens
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Contributions

All authors have read and approved the submitted manuscript. C. Cabib, O. Ortega, P. Clavé and N. Guanyabens have participate on design, analysis and writing the manuscript, while A. Ungueti, M Duh and M. Fernandez have performed the interpretation of radiologic data and helped with the writing and revision. V. Arreola and W. Do Nascimento help to get and analyze the VFS data as well as revise and contribute with final version of the document. At last E. Palomeras, have participated in drafting the manuscript.

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Correspondence to Pere Clavé.

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The study protocol was approved by the Ethical Committee of the Hospital de Mataró (CEIm 27/19).

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Guanyabens, N., Cabib, C., Ungueti, A. et al. The Impact of Periventricular Leukoaraiosis in Post-stroke Oropharyngeal Dysphagia: A Swallowing Biomechanics and MRI-Based Study. Dysphagia 38, 856–865 (2023). https://doi.org/10.1007/s00455-022-10509-2

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