Speech problems Dysphasia Overview: • A deficit in the higher language functions i.e. comprehension and generation. • Aphasia is a total absence. • Most commonly due to a left anterior circulation stroke. • If speech is internally consistent but nonsense, it is confusion not dysphasia. Receptive (Wernicke's) dysphasia • Temporal lobe lesion. • Patient can't follow a command e.g. lift a hand. If the problem is only with a series of commands, the more they can manage then the better the prognosis.

1. Speech problems
Slide made with the assistance of Medicos PDF app.
Find hundreds of books, slides, notes and articles
from:
https://bookapp.page.link/slideshare

2. Dysphasia
Overview:
 A deficit in the higher language functions i.e. comprehension and generation.
 Aphasia is a total absence.
 Most commonly due to a left anterior circulation stroke.
 If speech is internally consistent but nonsense, it is confusion not dysphasia.
Receptive (Wernicke's) dysphasia
 Temporal lobe lesion.
 Patient can't follow a command e.g. lift a hand. If the problem is only with a series of commands,
the more they can manage then the better the prognosis.
Expressive (Broca's) dysphasia
 Frontal lobe lesion.
 Can't generate speech.

3. Nominal aphasia
 Dominant posterior temporo-parietal lesion.
 Difficulty in recalling specific words or names, but rest of speech normal.
 Patient may not be able to name specific objects shown to them.
Conduction dysphasia
 Longitudinal fasciculus lesion.
 Patient can understand and speak, but can't repeat a phrase.

4. Dysarthria
 Poor articulation.
 Causes: bulbar or pseudobulbar palsy, or (less commonly) facial nerve palsy.
 Examination: test tongue (say la la la) and palate (ka ka ka) for bulbar function,
and lips (ma ma ma) for facial nerve function.
Dysphonia
 Reduced speech volume due to weak respiratory muscles or vocal cords.
 Causes: (pseudo)bulbar palsy, myasthenia gravis, Parkinson's, recurrent laryngeal
nerve invasion.

5. Bulbar and pseudobulbar palsy
 The 'bulb' refers to the medulla, and bulbar palsy is dysfunction of the
cranial nerves – 9 to 12 – whose nuclei lie within it.
 It presents with dysphonia, dysarthria, and/or dysphagia.
Bulbar palsy
• LMN lesion of the medulla (nuclei) or cranial nerve fibres.
• Causes:
 Brainstem stroke or tumour.
 MND, especially progressive bulbar palsy.
 Guillain Barré.
 Myasthenia gravis.
 Central pontine myelinolysis.
 Iatrogenic: surgery, radiotherapy.
• Distinguishing features:
 Fasciculating tongue which may sit in one side of the mouth.

6. Pseudobulbar palsy
• UMN lesion of the corticobulbar tract. Commoner than bulbar palsy.
• Causes:
 Stroke e.g. of the bilateral internal capsule.
 MS
 Progressive supranuclear palsy
 MND
 Tumours higher in the brainstem.
 Syphilis
• Distinguishing features:
 Bilateral defects.
 Paralysed tongue with donald duck speech.
 Also non-bulbar symptoms – as corticobulbar tract supplies all motor
cranial nerves – including hyperreflexia (jaw jerk, gag) and facial paralysis.
 Emotional lability.

7. Thank You
• Information gathered with the assistance of Medicos PDF app. Happy to share this information with
Medical students. Find hundreds of books, slides, notes and articles from
https://bookapp.page.link/slideshare