Changes in swallowing after cerebrovascular accidents: Incidence, natural history and repercussions on nutritional status, morbidity and mortality

Objective. To determine the frequency of dysphagia in CVA, its natural history and value as a risk factor of respiratory infection, malnutrition and death. Patients and methods. A prospective study was made of 18.7 consecutive patients with cerebrovascular accidents (CYA), A standardized test for dysphagia was done during the first two days of the illness and repeated three days a week. The levels of urea, total proteins and albumin were determined on admission and on discharge. The patients were questioned by phone after 6 months. Results. There was dysphagia of liquids in 36.4% of the patients. The incidence of dysphagia for semisolids was of the same frequency but more severe. Coma was the cause of inability to swallow in 25.7% of the patients. During their stay ill hospital one third of the patients with dysphagia died, one third became normal and one third still had dysphagia when they were discharged. After one week, one, three and six-months respectively, the cure rate for dysphagia was 29.4%, 4.1%, 55.9% and 55.9%, and survival 83.8%, 67.6%, 61.8% and 60.3%. Thus after 6 months only 3 patients (4.4%) were alive and dysphagic. Half of the 'cures' occur red in the first week and none occurred after more than 77 days. As compared to the non-dysphagic patients, the dysphagic patients had IO times more risk of respiratory infection, 18 times higher risk of death, greater loss of albumin and less loss of urea. Conclusions. There is a high prevalence of dysphagia in CVA and although functional prognosis is riot unfavorable, respiratory infections, malnutrition and death are frequent [REV NEUROL 1998; 27:759-66].