Comparison of disordered swallowing patterns in patients with recurrent cortical/subcortical stroke and first-time brainstem stroke

Objective: To describe the disordered swallowing patterns in recurrent cortical/subcortical stroke and first-time brainstem stroke. Design: A retrospective study. Subjects: Forty-seven consecutive patients, 28 with recurrent cortical/subcortical stroke and 19 with first-time brainstem stroke, referred for dysphagic evaluation to the rehabilitation department of a medical centre. Methods: Thirty-five male and 12 female patients with a mean age of 62.0 +/- 11.5 years were included. The median post-stroke duration was 17.0 days. The records of clinical examination and a videofluoroscopic study of swallowing were collected through chart review. The percentages of abnormalities seen at clinical examination and videofluoroscopic swallowing study between recurrent cortical/subcortical stroke and first-time brainstem stroke patients were compared using a chi-square test. Results: The recurrent cortical/subcortical patients suffered from a higher rate of impaired tongue movement, drooling and aphasia at clinical examination and a higher percentage of swallowing abnormalities in oral-preparatory and oral phases in the videofluoroscopic swallowing study. The abnormal videofluoroscopic findings in first-time brainstem stroke patients predominantly occurred in the pharyngeal phase. Both groups had more difficulties swallowing thin barium than they did swallowing the thick and paste barium. Conclusion: The recurrent cortical/subcortical stroke and first-time brainstem stroke patients show different manifestations in some parameters of both clinical examination and videofluoroscopic swallowing study.