AUTHOR=Han I Joon , Lee Ji-Eun , Song Ha-Na , Baek In-Young , Choi Jongun , Chung Jong-Won , Bang Oh Young , Kim Gyeong-Moon , Seo Woo-Keun 

TITLE=Imaging and clinical predictors of acute constipation in patients with acute ischemic stroke

JOURNAL=Frontiers in Neuroscience

VOLUME=Volume 17 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2023.1263693

DOI=10.3389/fnins.2023.1263693

ISSN=1662-453X

ABSTRACT=Background Constipation symptoms are highly prevalent in acute ischemic stroke, but the clinical and neuroimaging predictors are unknown. This study aimed to identify lesions and clinical features associated with acute constipation.Methods Data from acute ischemic stroke patients registered in a hospital-based stroke registry between January 2018 and December 2019 were analyzed. Clinical, laboratory, and imaging features were examined for associations with acute constipation. Using the topographic lesion on diffusion-weighted images, multivariate support vector regressionbased lesion-symptom mapping (SVR-LSM) was conducted and compared between the nonconstipation and acute constipation groups.Results A total of 256 patients (mean age 67 years, men: 64%) were included. Acute constipation was noted in 81 patients (32%). Initial stroke severity, represented by initial National Institutes of Health and Stroke Scale (NIHSS) scores, was associated with acute constipation. Laboratory parameters, including fibrin degradation products (FDP), fibrinogen, D-dimer, lipoprotein (a), and free fatty acid levels, also showed statistically significant differences between the non-constipation and constipation groups. FDP, D-dimer, and free fatty acid levels were independently associated with acute constipation in the logistic regression model after adjusting for initial NIHSS scores and potassium levels. SVR-LSM revealed that bilateral lesions in the precentral gyrus, insula, opercular part of the inferior frontal gyrus, the inferior parietal lobule, and lesions in the right middle frontal gyrus were significantly associated with acute constipation. The results were consistent after controlling for the initial NIHSS scores and poststroke potassium levels. When cardioembolic stroke subjects were excluded, the right insular and prefrontal cortex lesions lost their association with acute constipation.Conclusions Acute constipation symptoms in poststroke patients are mainly related to bilateral lesions in the insula, precentral gyrus, postcentral gyrus, and inferior parietal lobule.Clinically important predictors of acute constipation include initial neurological severity and thromboembolic markers of stroke.