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Chapter 26 - Dysarthria
- from Section 1 - Clinical manifestations
- Edited by Louis R. Caplan, Jan van Gijn
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- Book:
- Stroke Syndromes, 3ed
- Published online:
- 05 August 2012
- Print publication:
- 12 July 2012, pp 306-312
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Summary
With the widespread use of computerized tomography (CT), it has become evident that aphasia and other cortical syndromes can result from lesions limited to subcortical structures. Both single-photon emission computed tomography (SPECT) and positron emission tomography (PET) have shown that subcortical strokes are accompanied by important abnormalities of cortical metabolism and perfusion. Strokes in the basal ganglia and deep white matter tracts can produce disorders of oral and written language, apraxia, neglect, amnesia, apathy, and several other psychiatric disturbances. Multiple subcortical lacunar stroke and vascular white matter changes are associated with cognitive impairment, cognitive decline, depression, and dementia. Posterior hematomas, including the pulvinar and dorsal nuclei, are those most commonly associated with aphasia, because this is the only region of the thalamus connected with cortical language areas. Most of these subcortical lesions were located in the right hemisphere, indicating that right subcortical structures are dominant for hemispatial attention and intention.
Contributors
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- By Pierre Amarenco, Adrià Arboix, Marcel Arnold, Robert W. Baloh, John Bamford, Jason J. S. Barton, Claudio L. Bassetti, Christopher F. Bladin, Julien Bogousslavsky, Julian Bösel, Marie-Germaine Bousser, Thomas Brandt, John C. M. Brust, Erica C. S. Camargo, Louis R. Caplan, Emmanuel Carrera, Carlo W. Cereda, Seemant Chaturvedi, Claudia Chaves, Chin-Sang Chung, Isabelle Crassard, Hans Christoph Diener, Marianne Dieterich, Ralf Dittrich, Geoffrey A. Donnan, Paul Eslinger, Conrado J. Estol, Edward Feldmann, José M. Ferro, Joseph Ghika, Daniel Hanley, Ahamad Hassan, Cathy Helgason, Argye E. Hillis, Marc Hommel, Carlos S. Kase, Julia Kejda-Scharler, Jong S. Kim, Rainer Kollmar, Joshua Kornbluth, Sandeep Kumar, Emre Kumral, Hyung Lee, Didier Leys, Eric Logigian, Mauro Manconi, Elisabeth B. Marsh, Randolph S. Marshall, Isabel P. Martins, Josep Lluís Martí-Vilalta, Heinrich P. Mattle, Jérome Mawet, Mikael Mazighi, Patrik Michel, Jay Preston Mohr, Thierry Moulin, Sandra Narayanan, Kwang-Yeol Park, Florence Pasquier, Charles Pierrot-Deseilligny, Nils Petersen, Raymond Reichwein, E. Bernd Ringelstein, Gabriel J. E. Rinkel, Elliott D. Ross, Arnaud Saj, Martin A. Samuels, Jeremy D. Schmahmann, Stefan Schwab, Florian Stögbauer, Mathias Sturzenegger, Laurent Tatu, Pariwat Thaisetthawatkul, Dagmar Timmann, Jan van Gijn, Ana Verdelho, Francois Vingerhoets, Patrik Vuilleumier, Fabrice Vuillier, Eelco F. M. Wijdicks, Shirley H. Wray, Wendy C. Ziai
- Edited by Louis R. Caplan, Jan van Gijn
-
- Book:
- Stroke Syndromes, 3ed
- Published online:
- 05 August 2012
- Print publication:
- 12 July 2012, pp vii-x
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25 - Dysarthria
- from PART I - CLINICAL MANIFESTATIONS
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- By Paola Santalucia, Edward Feldmann, Brown University School of Medicine, Rhode Island Hospital, Providence, USA
- Edited by Julien Bogousslavsky, Université de Lausanne, Switzerland, Louis R. Caplan, Harvard Medical School
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- Book:
- Stroke Syndromes
- Published online:
- 17 May 2010
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- 24 May 2001, pp 334-340
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Summary
Introduction
Dysarthria is a pure motor disorder of speech, occurring in 24–29% of patients with cerebral ischemia (Arboix et al., 1990; Melo et al., 1992). It is characterized by dysfunction of the structures implicated in the control, initiation and coordination of speech output: lips, tongue, jaw, and palate, which are innervated by the facial, glossopharyngeal, vagal, and hypoglossal nerves. The dysarthric patient exhibits intact cortical language mechanisms and comprehension, is able to understand perfectly what he hears and has no difficulty in reading and writing, although his speech is inarticulate and may be unintelligible.
Lesions that cause dysarthria may occur in one of several locations along the neuraxis (Schiff et al., 1983; Yorkston et al., 1988). The upper and/or lower motor neuron may be involved as well as the extrapyramidal system from the basal ganglia to the cerebellum. Each region may receive blood supply from more than one artery. The examination of the patient with dysarthria is used to identify the specific type of abnormality. It is conducted by listening to the patient's speech during ordinary conversation, after testwords, or in the attempt of rapid repetition of lingual, labial, and guttural consonants. The clinical features of the dysarthria and the associated neurological findings identify the responsible lesion. Dysarthria has also been described as an isolated symptom (Ozaki et al., 1986; Caplan et al., 1990); in such circumstances the responsible lesion is suggested by the characteristics of the dysarthria itself and by imaging studies.
Defects in articulation may be subdivided into several types: upper motor neuron or spastic (pseudobulbar), lower motor neuron (neuromuscular), cerebellar–ataxic, hypo- and hyperkinetic.