Cerebellar dysarthria

50 Cerebellar dysarthria



Instruction


Ask this patient a few questions.



Salient features



Examination




• The speech may be scanning (enunciation is difficult, words are produced slowly and in a measured fashion) or staccato (in bursts). Scanning speech is more common in multiple sclerosis, whereas staccato speech is more common in Friedreich’s ataxia.


• Articulation is uneven, words are slurred and variations in pitch and loudness occur.


• Proceed by telling the examiner that you would like to carry out a neurological examination of the patient for cerebellar signs.


See Case 46 (Cerebellar syndrome) for discussion.



Diagnosis


This patient has scanning speech (lesion) caused by cerebellar involvement secondary to chronic alcohol abuse (aetiology).



Questions




What do you understand by the term dysarthria?


Dysarthria is impaired articulation of speech. It may result from lesions of muscles, myoneural junctions or motor neurons of lips, tongue, palate and pharynx. Common causes include mechanical defects such as ill-fitting dentures or cleft palate. Dysarthria may also result from impaired hearing which begins in early childhood.



Advanced-level questions




How would you test the different structures responsible for articulation?




• Lips: ask the patient to say, ‘me, me, me’


• Tongue: ask the patient to say, ‘la, la, la’


• Pharynx: ask the patient to say, ‘kuh, gut’


• Palate, larynx and expiratory muscles: ask the patient to say, ‘ah’. In palatal paralysis the patient’s speech is worse when the head is bent forwards.

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  3. Abnormal gait
  4. Dystrophia myotonica

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Cerebellar dysarthria

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