Sarcopenia is associated with poor prognosis in patients with acute stroke. While temporalis muscle thickness (TMT) and area (TMA) have been studied in various conditions, their association with stroke prognosis remains unclear.

To investigate the validity of TMT and TMA as poststroke outcome predictors, we performed a comprehensive search of the PubMed, CENTRAL, and Embase databases to identify pertinent studies published up to October 31, 2024. A meta-analysis of the pooled estimates of the temporalis muscle predictors was conducted, and the evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

This meta-analysis included 15 studies and revealed that both TMT and TMA were associated with functional outcomes and dysphagia risk in patients with stroke. Specifically, patients with better functional outcome had higher TMT value (mean difference [MD] = 0.84 mm, 95% confidence interval [CI] = 0.55–1.13, I² = 45%). Likewise, patients with better functional outcomes had larger TMA values (MD = 65.99 mm2, 95% CI = 0.41–1.06, I² = 85%). A lower TMT value at stroke onset was associated with increased dysphagia risk (MD = 1.63 mm, 95% CI = 0.74–2.52, I² = 50%). Subgroup analyses showed that the association between TMT and functional outcome was more evident in individuals aged 50 years or older and in Asian populations, with no significant differences observed between sexes. The certainty of evidence according to GRADE assessment ranged from low to moderate.

TMT and TMA measurements obtained from routine neuroimaging may serve as useful reference markers for functional prognosis in stroke patients.