Enlarged Perivascular Spaces and Swallow Dysfunction after Acute Ischemic Stroke 

Background: Post-stroke dysphagia (PSD) is a severe complication of stroke. Cerebral small-vessel disease (CSVD) is a major risk factor for stroke and is associated with swallowing difficulties. Accumulating evidence suggests that enlarged perivascular spaces (ePVSs) are a feature of CSVD. We explored whether ePVSs affect swallowing function in patients with acute ischemic stroke. Methods: This was a retrospective analysis of 395 patients with acute ischemic stroke who underwent swallowing examination after stroke who had a cerebral MRI at baseline. Swallowing function was ranked based on Functional Oral Intake Scale (FOIS) score, and ePVSs were rated using a 4-level severity score according to the number of ePVSs in the basal ganglia (BG-ePVS). Results: Post-stroke dysphagia was detected in 57.4% of the patients and was related to the presence of BG-ePVS. The degree of ePVS was associated with a strong increase in the risk for incident dysphagia, independent of other standard risk factors for dysphagia. A Spearman correlation analysis showed that an increased FOIS score correlated positively with an increase in the BGPS grade. Conclusions: : BG-ePVS are associated with swallowing dysfunction in patients with acute ischemic stroke. The larger the number of BG-ePVS, the more severe the post-stroke dysfunction in swallowing. Accordingly, ePVS should be considered a factor in the prediction of PSD.