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?
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