April 20, 2024, Live, Synchronous, 7-Hour Webinar

 Rethinking Dysphagia After Stroke: 
When the Lesion Doesn’t Tell the Whole Story

Ever looked at a brain scan and felt confident a patient couldn't have dysphagia because the stroke was “too small” or “not in a swallowing area,” only to be proven wrong at the bedside? Learn why the stroke lesion itself is only part of the story.

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Dr. Janina Wilmskoetter of the Medical University of South Carolina uses real MRI and modified barium swallow study (MBS/VFSS) cases to challenge common clinical assumptions about how stroke location predicts, or fails to predict, dysphagia. Learners will review the brain regions most consistently linked to swallowing impairment and current evidence on how lesion side and lesion size shape clinical presentation. The session then goes beyond the visible lesion to explain diaschisis - the process by which a stroke's effects extend into healthy, undamaged brain regions through disrupted white matter networks - and shows how this helps explain swallowing presentations that don't match what the scan alone would predict.

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The session also examines pre-stroke brain health, including age-related brain atrophy and cerebral small vessel disease, as a frequently overlooked factor that shapes both the severity of acute dysphagia and a patient's capacity for recovery. Clinical case examples throughout demonstrate how integrating brain imaging findings with MBS/VFSS results can sharpen assessment, guide treatment planning, and flag patients at risk for unexpected decline.

Learning Objectives:

1. Explain foundational neurological underpinnings of communication and swallowing.

2. List 3 or more brain regions that are crucial for swallowing control and likely cause dysphagia when lesioned.

3. Describe neural and systemic factors beyond the stroke lesion that contribute to variability in post-stroke dysphagia presentation and recovery.