Post-Stroke Dysphagia: Incidence, Diagnosis and Complications

Background: Swallowing dysfunction can complicate acute stroke and directly affect patient's prognosis and recovery through development of chest infection (respiratory morbidity), nutritional problems and dehydration. Objective: To study the relationship of post stroke dysphagia (assessed clinically and by pulse oximetry) with the stroke 'site and size, and with subsequent in hospital respiratory morbidity and mortality. Also to determine the predictive value of both tests, for respiratory morbidity Methods: Forty patients with acute stroke were examined neurologically. Staff Swallowing Assessment (SSA) was performed within 24 hours of admission along with pulse oximetry. Strokes were classified according to brain CT or MRI. In hospital respiratory morbidity and mortality, mode of nutrition and disability status at discharge were recorded. Results: Eighteen patients (45%) developed post stroke dysphagia (unsafe swallowing) during their hospital course, but only thirteen patients (32.5%) developed respiratory morbidity. In the hemorrhagic group 72% developed dysphagia and chest infection, but only 39% of the ischemic group developed dysphagia and 24% developed chest infection. Dysphagia was more common among those who had large seized lesion or GCS<12 or brain stem lesion. SSA had a sensitivity and specifity 77% and 70% respectively for predicting respiratory morbidity. Pulse oximetry corresponding figures were 85% and 93%. Conclusions: The presence of large sized lesion or GCS<12 is significantly related with subsequent dysphagia, respiratory morbidity and mortality. SSA failure and desaturation >2% on pulse oximetry are also significantly related with dysphagia, respiratory morbidity and mortality and dependency status at discharge. (Egypt J Neurol Psychiat Neurosurg. 2010; 47(1): 175-183)