Mr. Gaines, a 41-year-old male, was hospitalized for managem…
Mr. Gaines, a 41-year-old male, was hospitalized for management of hypertension and speech and swallowing difficulties. Eleven months ago, in the course of an evening, he developed left hemiplegia. Neurologic examination revealed left hemiparesis. Upper limb reflexes were hyperactive bilaterally, left greater than right. The speech examination noted the patient was nearly anarthric. He produced only a nasally emitted and resonated, quiet but strained-strangled undifferentiated vowel with great effort. With his lips closed he could produce a prolonged, strained /m/. Voluntary lip and jaw movements were slow and limited in range but were more extensive during reflexive swallowing; the jaw opened widely during a reflexive yawn. Suck, snout, and jaw reflexes were present. Tongue movement was minimal and slow; he was unable to extend it beyond the edge of the lower teeth, elevate, or move it laterally. The palate hung so low in the pharynx the that the uvula could not been seen. The patient produced a sharp cough. What type of dysarthria do you suspect?
Read DetailsMr. Sheridan, a 68-year-old male, presented with a 4-year hi…
Mr. Sheridan, a 68-year-old male, presented with a 4-year history of progressive difficulty getting into and out of chairs and a 2-3 year history of speech difficulty. Walking was slow with shuffling steps. His handwriting had deteriorated and was hard to read. During the oral mechanism exam, lingual tremulousness on protrusion and during lateral movements was noted. No other deficits were noted. Conversational speech, reading, and repetition displayed a remarkable degree of dysfluency; characterized by rapid repetition of initial sounds, syllables, and occasional words and phrases. Articulation was moderately imprecise and overall pitch and loudness variability were reduced. Speech AMRs were rapid and accelerated. Prolonged “ah” was hoarse. What do you suspect is the etiology of his condition?
Read DetailsMs. Lassiter, a 35-year-old woman presented with a 2-year hi…
Ms. Lassiter, a 35-year-old woman presented with a 2-year history of gradual mental deterioration, reduced ability to concentrate, and hand-writing difficulty. She complained of speech difficulty. Neurologic evaluation identified involuntary movements and balance difficulty, generalized motor impersistence, and mild cogwheel rigidity. Neuropsychological assessment confirmed the presence of significant cognitive limitations. MRI showed an abnormality in the right putamen that could represent iron deposition and mild generalized atrophy. During the speech examination rapid, unsustained, choreiform movements of the lower face, jaw, and tongue were present at rest. Involuntary tongue clicking was noted. She had difficulty maintaining a protruded tongue, open mouth, and lip retraction due to both motor impersistence and involuntary movements. Speech was characterized by an accelerated rate, imprecise articulation with irregular articulatory breakdowns, dysprosody, and variable rate. Vowel prolongation was characterized by low-amplitude tremor. Speech AMRs were irregular. Pitch and loudness variability was reduced, but pitch and loudness occasionally varied inappropriately. What type of dysarthria do you suspect?
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