Clinical Features and Voxel-Based-Symptom-Lesion Mapping of Silent Aspiration in Acute Infratentorial Stroke.
H Lesch, M Wittayer, M Dias and 4 others
PMID 37535137WHAT IT FOUND
Silent aspiration occurred in 40.5% of acute infratentorial stroke patients, doubling pneumonia risk.
Lesion location did not predict it. Do not rely on stroke severity scores alone; these patients need FEES assessment regardless of how mild their deficits appear.
Key findings
01Silent aspiration was detected in 34 of 84 patients (40.5%) and was associated with a significantly higher rate of pneumonia (47.1% vs 16.0%).
02Neither specific lesion location nor voxel-based lesion mapping predicted silent aspiration, meaning it can occur with any infratentorial stroke.
03Late FEES examination (>72 hours after admission) was associated with a threefold increased risk of silent aspiration and pneumonia compared to early examination.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Retrospective design with a relatively small sample size (84 patients). Selection bias: Only patients who underwent FEES were included, likely skewing the cohort toward those already suspected of having dysphagia. No control group of patients without infratentorial stroke. Voxel-based mapping did not identify specific culprit lesions, limiting anatomical precision. Timing of FEES varied, with late examinations showing higher aspiration rates, which may reflect disease progression rather than screening timing alone.
Declared interests
The study was funded by the Medical Faculty Mannheim of the University of Heidelberg. No other conflicts of interest were declared.
The easy way to misread this
Do not use NIH-SS scores to rule out silent aspiration risk. The study found that NIH-SS was a weak predictor and did not distinguish between patients with silent aspiration who developed pneumonia and those who did not. A patient with a low NIH-SS score can still have silent aspiration and require FEES.