gms | German Medical Science

Objective: Incidence and outcome of dysphagia is well known and reported in patients with ischemic stroke and therapy strategies are established. However, data on dysphagia in patients with aneurysmal subarachnoid hemorrhage (aSAH) is scarce. We therefore evaluated our institutional database to evaluate the incidence and risk factors for dysphagia after aSAH.

Methods: Between 01/2014 and 09/2017, 221 consecutive patients (138 women / 83 men) with aSAH were treated in our institution. Patient and aneurysm specific characteristics were entered prospectively into the neurovascular database and evaluated. Dysphagia evaluation and therapy were performed starting day 1 to 3 until discharge by a trained speech therapist at the neuro intensive care unit. Dysphagia was classified into 4 categories (none, mild, moderate, severe) according to the Bogenhausener dysphagia score (BODS). For multivariate analysis, dysphagia was dichotomized into none/mild, and moderate/severe dysphagia.

Results: Moderate/severe dysphagia was present in 97 of the 221 patients (43.9%) at discharge. In the multivariate analysis poor WFNS (p<0.0001; OR 11.8; CI 6.1-22.9), aneurysm location in the posterior circulation (p=0.02; OR 2.8; CI 1.1 -6.6) and older age (>60a) (p=0.037; OR 2.1; CI 1.1 -4.2) were predictors of moderate/severe dysphagia. Treatment modalities (clip or coil) did not correlate with dysphagia.

Conclusion: At the time of discharge 44% of all patients with aSAH suffer from moderate/severe dysphagia and may benefit from specialized treatment and therapy. Because all risk factors for severe dysphagia are assessable in the first days, early treatments (e.g. tracheostomy, PEG) to prevent morbidity caused by dysphagia need to be discussed. Further evaluation, especially long-term follow ups, have to be analyzed.