dysarthria
Introduction
Introduction The dysarthria refers to the organic damage of the neuro-muscle system related to verbal expression, which leads to weakening of the muscles of the vocal muscles, sputum, muscle tension, poor coordination, etc., causing inaccurate pronunciation, uneven rhyme, and flow. Speech disorders such as slowness and rhythm disorder. Patients with dysarthria are mainly characterized by inaccurate pronunciation, unclear vocabulary, changes in verbal and auditory characteristics such as sound, pitch, speed, rhythm abnormality and excessive nasal sound, which means that the words are ambiguous and not fluent.
Cause
Cause
Common causes of dysarthria are as follows:
(1) Muscle and neuromuscular joint diseases, such as myasthenia gravis, polymyositis, myotonic dystrophy, congenital muscle rigidity, periodic paralysis and so on.
(2) peripheral neurological diseases, such as Guillain-Barré syndrome, diphtheria polyneuritis, V, VII, IX, X, XII cranial nerve palsy, brain bottom (intracranial and extracranial) lesions (such as tumors, inflammation) , congenital malformations or vascular diseases, etc.).
(3) True bulbar palsy, including acute bulbar palsy and chronic progressive bulbar palsy. The former is found in acute poliomyelitis, brainstemitis, lateral medullary syndrome, vertebrobasilar system TIA, etc., while the latter is mainly found in medullary cavity, medullary compression, amyotrophic lateral sclerosis.
(4) pseudobulbar paralysis, such as brain or brain stem extensive lesions damage bilateral cortical brain stem bundles, can cause pseudobulbar paralysis. Common in vascular diseases, inflammation, multiple sclerosis, extensive head injury, cerebral palsy and so on.
(5) cerebellar lesions are found in hereditary ataxia, cerebellar tumor, abscess, trauma, acute cerebellitis, multiple sclerosis, cerebellar vascular disease.
(6) basal ganglia lesions found in hepatolenticular degeneration, hand and foot, chorea, Parkinson's syndrome.
Examine
an examination
Related inspection
Gonopharyngeal nerve examination sublingual nerve examination brain nerve examination
[clinical manifestations]
Patients with dysarthria are mainly characterized by inaccurate pronunciation, unclear vocabulary, changes in verbal and auditory characteristics such as sound, pitch, speed, rhythm abnormality and excessive nasal sound, which means that the words are ambiguous and not fluent. In serious cases, words are not divided, and words are not a sentence, which is difficult to understand. In the worst case, you can't talk at all, and you can't make a sound. However, the content and grammar expressed by the speech of patients with dysarthria are often normal, and there is no difficulty in understanding the language of others, but only the expression of oral language. The dysarthria can be the primary or only symptom of the patient or a secondary accompanying symptom.
The dysarthria caused by different causes has different clinical features, and often has specific accompanying symptoms. The dysarthria of upper motor neuron damage often has other manifestations of "pseudo-bulbar palsy" such as dysphagia, water and cough, and more often accompanied by strong crying, strong laughter and other symptoms. Dysfunctions caused by lower motor neuron damage often have dysphagia, and severe cases may have difficulty breathing. Myogenic dysarthria often has weakness or atrophy of the trunk and limb muscles. The dysarthria caused by cerebellar damage is often accompanied by symptoms such as ataxia, decreased muscle tone, and unstable balance of limb movement. The dysarthria caused by basal ganglia lesions may be associated with abnormal muscle tone and involuntary movements. The clinical manifestations of lesions with different articulation structures are also different.
(a) tongue paralysis
When the XII cranial nerve damage leads to the tendon of the tongue, it mainly causes the vocal consonants s, z, r such as "four", "ten", "purple", "day" and so on. ", "special", "le" and so on are ambiguous. Early patients with lesions often feel that the movement of the tongue becomes sluggish, and the tongue is "stupid" and "meat jump". After the condition is gradually aggravated, the tongue can't move at all, and the tongue is at the bottom of the mouth, and it can hardly make a tongue. For the dysarthria caused by lower motor neuron damage, patients often have atrophy of the tongue muscle, the tongue becomes smaller, the tongue is soft and flaccid, and there are many deep grooves on the tongue.
(two) lip paralysis
VII When the brain damage causes lip muscle weakness and weakness, it can affect lip sounds b, p, m such as "package", "throw", "cat", "glass", "wave", "touch" and so on. The pronunciation of f, such as "flying" and "fog", causes the patient's lips and lip tones to be ambiguous. In addition, patients with lip muscle atrophy, can be expressed as thinning lips, more wrinkles, lip muscle weakness caused the patient can not whistle, pouting difficult.
(c) soft palate and throat muscle paralysis
When the pharyngeal muscles of the IX and X brains are weak or paralyzed, the pronunciations of the initials g, k, and h are as follows: "high", "", "good", "", "", "Drinking" is especially difficult. Early patients with lesions often only have a nasal sound when they have a long throat sound. When the nose is closed, the nasal sound disappears. After the disease is aggravated, the sound is a typical nasal sound. When the breath is pronounced, the nasal cavity leaks and the sentence is short, and the pronunciation is ambiguous. In addition, patients often have difficulty swallowing, drooling, eating cough, food is easy to flow out of the nostrils.
When the patient's V-brain nerve (sports branch) is damaged, it causes masticatory tendon and atrophy, which can make the mouth movement disorder and affect the speech. When the bilateral damage occurs, the patient can not open the mouth at all.
Diagnosis
Differential diagnosis
Symptoms of dysarthria need to be distinguished from the symptoms below.
(a) aphasia
Aphasia refers to clinical syndromes that cause speech disorder in the brain due to lesions in the language nerve center (often the dominant hemisphere), leading to abstract signal thinking disorder and loss of oral and written expression and comprehension. Aphasia does not include linguistic symptoms caused by disturbance of consciousness and general mental retardation, nor does it include audible, visual, writing, pronunciation, and other sensations of language and reading, and writing disorders. Defects in language function caused by congenital or juvenile diseases are not aphasia. Different specific parts of the dominant hemisphere are damaged, and different types of aphasia can occur:
A motor aphasia occurs when the back of the front is damaged.
2 The upper back is the center of the listening language, and the sensory aphasia occurs when the damage occurs.
The middle part of the 3 middle and back is the writing center. When the lesion is in the patient, the patient cannot express it in words, and there is a loss of writing.
4 corners are the reading center. When they are damaged, they can't read the words and the meaning of the words, and there is a dyslexia.
5 The area between the upper back and the corner is the naming center of the object, and a nominal aphasia occurs when the lesion is damaged. The most common cause of aphasia is cerebrovascular disease, followed by brain inflammation, trauma, and degeneration.
(two) mutism
Silent disorder refers to the absence of organic lesions in the speech-expressing organs of the patient, and the intellectual development is also barrier-free, but the patient is silent and does not speak for a long time. The main functional mutexes are mainly the following.
1. Selective mutism: It occurs mostly in children with sensitive, timid, and secluded personality. The children are often ill due to excessive parental love, protection, or first-time family leave, environmental changes, etc. Some cases may be related to genetic factors. The high selectivity of "silent" is the hallmark of this disease. Children are silent in certain people, people or in certain environments, but speak quietly in others and in the environment.
2. Hemorrhoids: When patients have silent symptoms, they often appear with snoring stupor. If there is no stupid stiffness, they only show silence, while writing, gestures and other movements are very agile, and facial expressions are also very lively. Silent performance, like other clinical symptoms, has the characteristics of sudden suddenness and easy acceptance of suggestion.
3. Tension mutism: The patient appears to be silent, or has a fragmented language, and may be accompanied by symptoms such as rejection, violation, stupor, waxy flexion, and impulsivity.
4. Delusional mutism: It is common for people around the world to disagree with the delusional content of the patient, and refuse to talk to the surrounding people and to remain silent because of the illusion or delusional content "command" the patient. The patient has no violations, impulsiveness or stiffness.
5. Depression: The patient may have silent symptoms, manifested as stupor or muttering, the patient's face is mournful, sometimes accompanied by paroxysmal anxiety, and the severe condition is absolutely silent.
(3) Loss of sound
Loss of sound, also known as difficulty in pronunciation, refers to vocal cord vibration disorder caused by vocal cord activity disorder or respiratory muscle paralysis and respiratory rhythm disorder caused by the laryngeal and its dominating nerve damage. The dominating nerves of the larynx are the branches of the vagus nerve (upper laryngeal nerve and recurrent laryngeal nerve). Any lesion that invades and compresses the nerve on the path of the recurrent laryngeal nerve can cause vocal cord paralysis and hoarseness. In the early stages of laryngeal muscle paralysis, the vocal cords are weak and the sound is low and rough. As the laryngeal tendon progresses, the bilateral vocal cords remain in the neutral position without movement, leaving only one slit, and the signs of the symptoms are aphasia and inspiratory difficulty and wheezing. At this point, the trachea should be cut to maintain life. However, patients who have only aphasia without breathing difficulties are mostly rickets.
(4) Stuttering
Stuttering is a kind of phonological rhythm disorder. It is a phonological disorder that causes repetition of words or interruption of speech due to different reasons. When speech expression is not fluent, it is often accompanied by body twitching action and facial abnormality. Stuttering occurs mostly in children and generally gradually improves or disappears with age, and a few can last into adulthood. Stuttering may be the result of a combination of physical and psychological factors. Due to the tension of the pronunciation-breathing organs, the rhythm of the language is dysfunctional, which is more likely to occur when excited, fearful or emotional. It can be expressed as the first word can not be pronounced, the first word is repeated, the word is blocked in the middle of the discourse, or the meaning is repeated repeatedly. When the child speaks, it can be accompanied by lame, waving, squeezing, pouting, trembling, and shaking of the trunk. And easy to suffer from stuttering, resulting in loneliness, inferiority, shame and other personality, some children are often prone to excitement or irritability, accompanied by emotional instability and sleep disorders. The common types of stuttering are as follows.
1. Congenital left-mouth stuttering
It refers to the patient's congenital benefit, due to the compulsory education of the day after tomorrow, forced to change to the right, so the words are not fluent, resulting in stuttering.
2. Thinking too fast stuttering
It means that because of the broad and rapid thinking, the mouth can not catch up, resulting in stuttering.
3. Spiritual stuttering
Refers to the language of the language, the language expression is suppressed, resulting in aphasia. The child has a history of trauma and may have speech, nervousness, loneliness, behavioral withdrawal or irritability, and emotional instability.
4. Dialectic stuttering
Refers to the change of dialects during the children's learning, or the study of two or more different dialects leading to stuttering.
5. Familial stuttering
Patients often have a family history, and even many people in the same family are sick. Some people think that it is related to genetic factors, and some people think that it is induced by external factors on the basis of genetics. The main external cause is the poor environment for learning the language, such as the stuttering of the parents, or the parents' speaking fast, ambiguous, and the children are not easy to imitate.
(5) Language pronunciation disorder
Due to congenital deficiency or early childhood developmental disorders, speech function development defects, leading to hoarseness or various hoarseness and other dysfunction are called language development disorders. Deaf-mute disease refers to severe deafness or total paralysis caused by congenital factors or various diseases in infants and young children. Children who are deaf can not learn language and become dumb. In addition, severe intellectual development delays or disorders, the use of functional insufficiency, etc. can cause hoarseness.
