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dysarthria

A motor disorder that results in difficulty in motor speech mechanisms. Dysarthria does not necessarily mean aphasia. Classification: 1) lower motor neuron dysarthria 2) spastic dysarthria (rigid dysarthria) 3) ataxic dysarthria 4) acquired stuttering Etiology: 1) strokes a) lacunar infarct: internal capsule, corona radiata, pons b) basilar artery occlusion c) cerebellar strokes 1] dentate nucleus 2] brachium conjunctivum 3] cerebellar cortex pathology has no effect on dysarthria d) cerebral infarcts extending into the subinsular region [8] e) dysarthria-clumsy hand syndrome 2) neurodegenerative disorders a) parkinsonism [5] - complication of gamma knife laser surgery b) amyotrophic lateral sclerosis with frontal lobe dysfunction [6] c) Huntington's disease [7] d) spinocerebellar ataxia [9] e) multiple sclerosis f) pseudobulbar palsy [10] g) progressive supranuclear palsy [11] h) Wilson's disease [12] i) corticobasal degeneration j) Creutzfeld-Jakob disease [16] k) Machado-Joseph disease [18] l) progressive bulbar palsy [20] m) Guillain-Barre syndrome [20] n) myasthenia gravis [20] i) Friedreich ataxia [21] 3) head trauma [17] 4) infections a) borreliosis (case report) [3] b) diphtheria [20] c) poliomyelitis [20] 5) food poisoning - ciguatoxin [22] 6) laryngeal dystonia (spasmodic dysphonia) Pathology: 1) defect in the muscular control of speech a) lips, tongue, palate, pharynx, larynx, respiratory muscles b) dependent upon - cranial nerve 5, cranial nerve 7, cranial nerve 10, cranial nerve 12 & their brainstem motor nuclei - phrenic nerve c) motor cortex via corticobulbar tract controls speech d) extrapyramidal modulation by 1] basal ganglia 2] cerebellum 2) the central symbolic aspect of language is not affected by dysarthria, but may be affected by other pathology accompanying dysarthria Clinical manifestations: 1) words may be nasal, slurred or indistinct 2) inability to repeat 'tongue twisters' such as 'hippopotamus' 3) manifestations frequently accompanying dysarthria a) ataxia b) aphasia c) dysphagia d) dystonia e) hemiparesis Radiology: - magnetic resonance imaging Management: 1) speech therapy 2) orofacial & articulation exercises [2] 3) palatal prosthesis [13] 4) Botulinum toxin A [15]

Related

dysarthria clumsy hand syndrome

Specific

anarthria ataxic dysarthria (includes scanning dysarthria) fluency disorder lower motor neuron dysarthria spastic dysarthria (rigid dysarthria) stuttering; stammering

General

speech impairment

References

  1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
  2. Robertson S, Int J Lang Commun Disord 36S:292, 2001
  3. Gustaw K et al, Ann Agric Environ Med 8:95, 2001
  4. Devust G et al, Arch Neurol 59(4):567, 2002
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  13. Esposito SJ et al, J Prosthet Dent 83(1):90, 2000
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  15. Tan EK et al, Neurology 53(9);2102, 1999
  16. Spencer MD et al, BMJ 324:1479, 2002
  17. Krays JK & Jankovic J, Neurosurgery 50(5):927, 2002
  18. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 135
  19. A Guide to Physical Examination and History Taking, Barbara Bates et al (eds), 6th ed, JB Lippincott, Philadelphia, 1995
  20. Principles of Neurology, 4th ed, Adams RD & Victor M (eds) McGraw-Hill, Inc, New York, 1989
  21. Berciano J, Mateo I, De Pablos C, Polo JM, Combarros O. Friedreich ataxia with minimal GAA expansion presenting as adult-onset spastic ataxia. J Neurol Sci. 2002 Feb 15;194(1):75-82. PMID: 11809170
  22. Ruprecht K et al, Drsch Med Wochenschr 126:821, 2001