Neurogenic Dysphagia in Subdural Hematoma

Sae-Yeon Won; Simon Krieger; Daniel Dubinski; Florian Gessler; Bedjan Behmanesh; Thomas M Freiman; Juergen Konczalla; Volker Seifert; Sriramya Lapa

doi:10.3389/fneur.2021.701378

Neurogenic Dysphagia in Subdural Hematoma

Front Neurol. 2022 Jan 26:12:701378. doi: 10.3389/fneur.2021.701378. eCollection 2021.

Authors

Sae-Yeon Won¹, Simon Krieger¹, Daniel Dubinski¹, Florian Gessler¹, Bedjan Behmanesh¹, Thomas M Freiman¹, Juergen Konczalla¹, Volker Seifert¹, Sriramya Lapa²

Affiliations

¹ Department of Neurosurgery, University Hospital, Goethe University, Frankfurt, Germany.
² Department of Neurology, University Hospital, Goethe University, Frankfurt, Germany.

Abstract

Introduction: Dysphagia is a common and severe symptom of traumatic brain injury (TBI) affecting up to 78% of patients. It is associated with pneumonia, increased morbidity, and mortality. Although subdural hematoma (SDH) accounts for over 50% of TBI, the occurrence of dysphagia in this subtype has not been investigated yet.

Methods: All patients with SDH admitted to the author's institution between the years 2007 and 2020 were included in the study. Patients with SDH and clinical suspicion for dysphagia received a clinical swallowing assessment by a speech and language pathologist (SLP). Furthermore, the severity of dysphagia was rated according to swallowing disorder scale. Functional outcome was evaluated by the Glasgow outcome scale (GOS).

Results: Out of 545 patients with SDH, 71 patients had dysphagia (13%). The prevalence of dysphagia was significantly lower in the surgical arm compared to the conservative arm (11.8 vs. 21.8%; OR 0.23; p = 0.02). Independent predictors for dysphagia were GCS <13 at admission (OR 4.17; p < 0.001), cardiovascular disease (OR 2.29; p = 0.002), and pneumonia (OR 2.88; p = 0.002), whereas the operation was a protective factor (OR 0.2; p < 0.001). In a subgroup analysis, right-sided SDH was an additional predictor for dysphagia (OR 2.7; p < 0.001). Overall, patients with dysphagia improved significantly under the SLP treatment from the initial diagnosis to hospital discharge (p < 0.01). However, a subgroup of patients with the most severe grade of dysphagia showed no significant improvement. Patients with dysphagia had significantly worse outcomes (GOS 1-3) compared to those without dysphagia (48.8 vs. 26.4%; p < 0.001).

Conclusion: Dysphagia is a frequent symptom in SDH, and the early identification of dysphagia is crucial regarding the initiation of treatment and functional outcome. Surgery is effective in preventing dysphagia and should be considered in high-risked patients.

Keywords: dysphagia; functional outcome; predictor; speech and language pathologist; subdural hematoma.