Dysarthria-clumsy hand syndrome

Introduction The patient has severe dysphonia, difficulty swallowing, and a central facial lingual fistula. The lateral hand is weakly accompanied by slow movements, clumsiness (especially fine movements such as writing is more difficult), finger nose test is not allowed, gait is not Stable, hyperreflexia and pathological reflex. The lesion is located at the upper 1/3 and the lower 2/3 junction of the base of the pons, and may also have ipsilateral ataxia. Dysarthria refers to speech disorders caused by neuropathy, speech-related muscle paralysis, decreased contractility, or incoordination. Emphasis on changes in breathing, resonance, pronunciation, and rhythm, from the brain to the muscle itself can cause speech symptoms.

Cause

Small luminal lesions caused by small lesions in the basal ganglia or pons.

an examination

Related inspection

Pathological reflex examination refers to nasal test posture and gait

It is characterized by obvious dysarthria, mild dysfunction of one hand and fine dyskinesia. It may be accompanied by ipsilateral central facial palsy, hyperreflexia and pathological signs, gait during walking, but no sensory disturbance. This type of disease has no TLA before the disease, and the onset is urgent, and the symptoms quickly reach a peak. The lesion is located at the upper 1/3 and 2/3 junction of the base of the pons or at the uppermost part of the inner capsule.

Differential diagnosis

Bad sound formation - differential diagnosis of hand clumsy syndrome:

(1) Simple exercise hemiparesis (PMH): The most common account of 40% to 60% is characterized by objective examination of no sensory disturbance, visual field defect, aphasia, disuse or loss of recognition; only one side of the face and upper and lower limbs are weak or Incompleteness. The lesion can occur in the inner cerebral pons, the basal ganglia of the brain, the cerebral cortex, the radiation crown, etc., often recover within 2 weeks but is prone to recurrence.

(2) Pure sensory stroke (PSS): no muscle disorder, dizziness, diplopia, aphasia and visual field defects, but only one side of the face and upper and lower limbs. The lesion is located in the posterior nucleus of the thalamus, usually caused by the infarction of the thalamic perforating branch of the posterior cerebral artery. A small number of cases can be caused by lesions of the spinal cord, thalamus, bundle thalamus, and cortical bundles. It can also be caused by lesions invading the outer thalamus and the radioactive crown of the posterior limb of the internal capsule, often recovering within a few weeks.

(3) Sensory exercise stroke (SMS): manifested as one side of the face, trunk and upper and lower limbs. Sensory disturbances and palsy of the face and upper and lower limbs, unconsciousness, memory impairment, aphasia, loss of recognition and loss of use. In the past, this type was considered to be rare. In recent years, domestic and foreign literature reports are second only to PMH. The lesion is located in the posterior lateral nucleus of the thalamus and the posterior limb of the internal capsule. It is usually caused by occlusion of the thalamic penetrating branch or posterior choroidal artery of the posterior cerebral artery, and the prognosis is good.

(4) Ataxia-induced hemiparesis (HAH): manifested as hemiparesis and cerebellar ataxia on the contralateral side of the lesion and lower extremity than the upper limb sometimes accompanied by sensory disturbance nystagmus dysplasia poor dysarthria to one side dumping lesion It can occur in the basal part of the pons or in the inner capsule, and the cerebellum can also recover within a few weeks.

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