Dysarthria in acute ischemic stroke
Dysarthria in acute ischemic stroke
复制标题
急性缺血性脑卒中的构音障碍
作者：
P. Urban;S. Wicht;G. Vukurevic;C. Fitzek;S. Fitzek;Peter Stoeter;C. Massinger;H. Hopf
背景和目的：虽然构音障碍是脑缺血的常见症状，但关于其解剖学特异性、相关临床特征谱和病因机制的信息很少。方法：回顾性分析68例经MRI或CT证实的单发脑梗死后突发构音障碍患者的临床资料。结果：在52.9%的患者中，构音障碍与典型的腔隙性卒中综合征相关。孤立性构音障碍和构音障碍-中央性面舌轻瘫的发生率分别为2.9%（n = 2）和10.3%（n = 7）。在11.7%（n = 8）的患者中观察到构音障碍-笨拙手综合征，27.9%（n = 19）的患者与纯运动性轻偏瘫和/或共济失调性轻偏瘫相关。52.9%（n = 36）的病变由小血管疾病引起，11.8%（n = 8）的病变由心源性栓塞引起，仅4.4%（n = 3）的病变由大血管疾病引起。脑区位于初级运动皮层的下部（5.9%; n = 4），半卵圆中心中部（23.5%; n = 16脑桥基底部（30.9%; n = 21）和腹侧脑桥延髓连接部（1.5%; n = 1）。孤立性小脑梗死累及小脑上级动脉区的喙旁区。结论：小脑外梗死导致构音障碍位于所有患者的沿着过程中的锥体束。这一发现与90.7%（n = 62）患者中频繁发生相关锥体束体征相关。所有病例中，导致构音障碍的孤立性小脑梗死均位于小脑上级动脉区域。
Background and purpose: Although dysarthria is a frequent symptom in cerebral ischemia, there is little information on its anatomic specificity, spectrum of associated clinical characteristics, and etiologic mechanisms. Methods: An investigation of 68 consecutive patients with sudden onset of dysarthria due to a single infarction confirmed by MRI or CT was conducted. Results: Dysarthria was associated with a classic lacunar stroke syndrome in 52.9% of patients. Isolated dysarthria and dysarthria–central facial and lingual paresis occurred in 2.9% (n = 2) and 10.3% (n = 7), respectively. Dysarthria–clumsy hand syndrome was observed in 11.7% (n = 8) of patients and associated with pure motor hemiparesis and/or ataxic hemiparesis in 27.9% (n = 19). The lesions were due to small-vessel disease in 52.9% (n = 36), to cardioembolism in 11.8% (n = 8), and to large-vessel disease in only 4.4% (n = 3) of cases. Infarctions were located in the lower part of the primary motor cortex (5.9%; n = 4), middle part of the centrum semiovale (23.5%; n = 16), genu and ventral part of the dorsal segment of the internal capsule (8.8%; n = 6), cerebral peduncle (1.5%; n = 1), base of the pons (30.9%; n = 21), and ventral pontomedullary junction (1.5%; n = 1). Isolated cerebellar infarctions affected the rostral paravermal region in the superior cerebellar artery territory. Conclusions: Extracerebellar infarcts causing dysarthria were located in all patients along the course of the pyramidal tract. This finding correlates with the frequent occurrence of associated pyramidal tract signs in 90.7% (n = 62) of patients. Isolated cerebellar infarcts leading to dysarthria were in all cases located in the territory of the superior cerebellar artery.