关键词: 卒中; 吞咽障碍; 功能磁共振成像; 吞咽中枢

Abstract: Objective To identify the change of swallow related central activation in ischemic stroke patientscompared with healthy volunteers in the same swallow tasks.Methods Five ischemic stroke patients with dysphagia and seven healthy adult volunteers werestudied utilizing blood oxygenation level-dependent technique on a 3.0 T magnetic resonancescanner(Seimens). Subjects swallowed 1 ml water bolus after it was infused into their oralcavity through a plastic catheter placed in the midline in certain interval time(20, 25 or 30 s inrandomized sequence) and total 11 boluses were injected. Patients also undertook videofluoroscopicexamination during drinking 5 ml 60% w/v barium.Results Videofluoroscopy investigation indicated significant delayed pharyngeal swallow withmedian latency time to be 0.09(0.03－0.15) s. Two patients had mild residue in epiglottic valleculaand one patient had decreased sensation of pharynx. There were no other significant abnormalitiesin videofluoroscopic examination. Patients had no insular activation but the anterior cingule wasactivated, while not in volunteers. The sites of activated motor cortex in patients were less thanthose in volunteers.Conclusion No insular activation indicates that voluntary control of swallow in patients isdecreased which may lead to delayed pharyngeal swallow. Activation areas of motor cortex inpatients smaller than volunteers may be associated with the voluntary control of swallowing injuredor weakness of swallowing muscles.

Key words: Stroke; Dysphagia; Functional magnetic resonance imaging; Centra of swallow