Dysarthria

Dysarthria is the inability to form or produce understandable speech due to lack of motor control over peripheral

TABLE 6-1

-- USEFUL STUDIES IN THE EVALUA"

riON OF SPEECH AND LANGUAGE DISORDERS

Disorder

Neuroimaging

Electrophysiology

Fluid and Tissue Analysis

Neuropsychology Tests

Other Tests

DYSPHONIA

Muscle paralysis or fatigability

Mass lesion compressing the tenth cranial nerve, or on the vocal cords

Abnormal decrement of CMAP with repetitive stimulation in myasthenia gravis. Single-fiber EMG showing jitter in NMJ defects

Carcinoma of the vocal cords, carcinomatous meningitis

Normal language and cognitive function

Vocal cord pathology visualized by direct or indirect laryngoscopy

DYSARTHRIA

Spastic dysarthria

Multiple subcortical white matter disease

Prolonged sensory and visual evoked potentials in multiple sclerosis

Oligoclonal bands in CSF in multiple sclerosis

Pseudobulbar affect, psychomotor slowing, retrieval memory deficit

Flaccid dysarthria

Brain stem lesion, atrophy, or normal

Fibrillation, fasciculation and neurogenic recruitment on EMG testing, prolonged latencies

Inereased protein in CSF with Guillain-Barre syndrome, carcinomatous meningitis

Normal language and cognitive function

Ataxia dysarthria

Atrophy of cerebellum, stroke or cerebellar tumor

Decreased CMAP, SNAP in axonal polyneuropathy secondary to alcohol. CMAP potentiation with Eaton-Lambert syndrome

Increased CSF protein, anti-Purkinje cell antibodies, vitamin E deficiency

Normal language

Prolonged latencies of evoked potentials in multiple sclerosis

Extrapyramidal dysarthria

Stroke in basal ganglia atrophy of the caudate

Mild cognitive decline, psychomotor slowing

APHASIA

Perisylvian aphasia

Stroke, tumor, abscess in pensylvian area

Slowing over the frontoparieto-temporal region on EEG

Inereased cholesterol, anticardiolipid antibodies

Decreased verbal memory

Holter and echocardiogram to rule out embolic causes of stroke, chest x-ray study

Extrasylvian aphasia

(transcortical)

Stroke in border zone vascular territory

Slowing over the left hemisphere on EEG

Doppler study of the carotids to rule out occlusion

Subcortial

Stroke in striatocapsular region or thalamus

Psychomotor slowing and possible decreased verbal memory

Nonlocalizing (anomic)

Generalized atrophy or left hemisphere lesion

Slowing over the temporal lobes over the left hemisphere on EEG

Plaques and tangles or spongiform changes on brain biopsy

Prominent cognitive deficits visuospatial, praxis, memory

Apolipoprotein E

OTHER DISORDERS

Alexia without agraphia

(L) Occipital inlarct involving the splenum of the corpus callosum

EEG slowing over the (L) occipital cortex

Alexia with agraphia

Generalized atrophy or focal infarct in left parietotemporal junction

(L) Centrotemporal slowing on EEG

Associated Gerstmann's syndrome plus anomia constitutes the angular gyrus syndrome

Reiterative speech

Border zone vascular infarct or generalized atrophy

(L) hemisphere slowing on EEG

Plaques and tangles or spongiform changes on brain biopsy

Multiple cognitive deficits when there is underlying degenerative disorder

Psychiatric disease

Usually normal or generalized atrophy

Normal

Abnormal chemistry panel, urine culture, positive hemoculture, abnormal liver or renal funetion

Normal

Normal

Multiple cognitive deficits

Bizarre thought content, flight of ideas, grandiosity, word salad

CMAP, Compolmd musele aetion potential; CSF, eerebrospinal fluid EEG, eleetroeneephalograin; EMG, eleetromyogram; NMJ, neuromllseular junetion; SNAP, sensory nerve aetion potential.

_TABLE 6-2 -- SPEECH DISORDERS_

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