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1.
Rev. CEFAC ; 23(1): e8220, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155318

ABSTRACT

ABSTRACT Purpose: to identify the knowledge produced in national and international researches on speech and language disorders in Amyotrophic Lateral Sclerosis, regarding the type of research and approach in different areas. Methods: an integrative review performed on databases, using the following descriptors: Amyotrophic Lateral Sclerosis, Dysarthria, Language Disorders, Speech Production Measurement and Speech Disorders. The inclusion criteria covered articles that addressed motor speech and language disorders from 2013 to 2018, excluding duplications, and categorizing valid articles for analysis. Results: 83 articles were selected, after screening the titles and abstracts. A large scientific production from different countries and areas, mainly Speech Therapy and Neurology, was found. Most of them was clinical research (65.06%), with a main focus on speech motor disorders (42.16%), speech and language motor disorders, cognition and behavior (27.71%), and language disorders (12.06%). Conclusion: researches found were mostly clinical and aimed at determining the diagnosis of disorders in different areas of knowledge. With regard to communication, few studies have been found in Brazil, and international studies addressed high technology. The results confirmed the heterogeneous nature of the disease, which shows, in addition to motor impairment of speech, cognitive, behavioral and language impairments.


RESUMO Objetivo: identificar o conhecimento produzido em pesquisas nacionais e internacionais das alterações de fala e de linguagem na Esclerose Lateral Amiotrófica, quanto tipo de pesquisa e abordagens em diferentes áreas. Métodos: revisão integrativa realizada em bases de dados, utilizando-se os descritores Amyotrophic Lateral Sclerosis, Dysarthria, Language Disorders, Speech Production Measurement e Speech Disorders. Os critérios de inclusão abrangeram artigos que abordassem alterações motoras de fala e de linguagem de 2013 a 2018, excluindo-se duplicações, categorizando-se os válidos para análise. Resultados: selecionou-se 83 artigos, após triagem dos títulos e resumos. Foi encontrada grande produção científica de diferentes países e áreas, principalmente Fonoaudiologia e Neurologia, na maioria pesquisas clínicas (65,06%), com foco principal em alterações motoras da fala (42,16%), alterações motoras de fala e linguagem, cognição e comportamento (27,71%) e alterações de linguagem (12,06%). Conclusão: as pesquisas encontradas foram, na maioria, clínicas e com objetivo determinar diagnóstico das alterações em diferentes áreas do conhecimento. No que se refere à comunicação, foram encontrados poucos estudos no Brasil e os internacionais voltavam-se à alta tecnologia. Os resultados confirmaram o caráter heterogêneo doença, que evidencia, além de comprometimento motor da fala, prejuízo cognitivo, comportamental e de linguagem.


Subject(s)
Humans , Health Knowledge, Attitudes, Practice , Dysarthria/etiology , Amyotrophic Lateral Sclerosis/complications , Language Disorders/diagnosis , Language Disorders/etiology
2.
Rev. Hosp. Clin. Univ. Chile ; 32(1): 52-59, 2021.
Article in Spanish | LILACS | ID: biblio-1151924

ABSTRACT

Communication is an essential part of our social participation and the need to know how to evaluate and deal with its alterations is essential when working with people with neurological pathologies such as Multiple Sclerosis (MS). Purpose: to carry out a bibliographic review and group information related to communication problems, describing useful instruments for timely evaluation in the different areas involved. Material and method: bibliographic review related to the subject. Results: People with MS can face differents communication problems (aphasia, dysarthria or cognitive communicative disorder), it is important to have the characterization of these disorders and with tools that specifically carry out a pertinent evaluation with common language among experts. Conclusions: considering the importance of communication, its disorders as a consequence of MS and the forms of evaluation are a priority when intervening with this population. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Communication Disorders , Multiple Sclerosis/complications , Aphasia , Cognition Disorders , Dysarthria , Multiple Sclerosis/physiopathology
3.
Rev. colomb. anestesiol ; 48(3): 162-163, July-Sept. 2020. graf
Article in English | LILACS, COLNAL | ID: biblio-1149788

ABSTRACT

Classic myotonic dystrophy is a multisystem disorder that results from RNA toxicity and is one of the commonest adult onset muscular dystrophies. Patients often present with muscle stiffness from myotonia and dysphagia or dysarthria from laryngopharyngoesophageal muscle weakness. Benign electrocardiogram changes such as first degree atrioventricular block are commonly present and rarely merit further work up. Occasionally, patients develop advanced conduction defects which can unexpectedly progress to complete heart block perioperatively


La distrofia miotonica clásica es un trastorno multi-sistémico que resulta de la toxicidad del RNA y es una de las distrofias musculares más comunes en adultos. Los pacientes suelen presentar rigidez muscular por la miotonía, así como disfagia o disartria por debilidad muscular laringo-faríngea-esofágica. Los cambios benignos en el electrocardiograma, como el bloqueo auriculoventricular de primer grado, suelen estar presentes y rara vez merecen un análisis más profundo. Ocasionalmente, los pacientes desarrollan defectos de conduccion avanzados que pueden progresar inespera-damente para completar el bloqueo cardiaco perioperatorio.


Subject(s)
Humans , Atrioventricular Block , Heart Block , Image Processing, Computer-Assisted , RNA , Dysarthria , Electrocardiography , Cardiac Conduction System Disease , Myotonia
4.
Article in Chinese | WPRIM | ID: wpr-879796

ABSTRACT

A boy, aged 2 years and 4 months, had a sudden onset of blepharoptosis of the right eyelid, accompanied by the mouth deviated to the right side, drinking cough, nystagmus, and developmental regression. Cranial MRI showed softening lesions formed after infarction of the right dorsolateral medulla oblongata, while head CT angiography showed no imaging of the proximal part of the V4 segment of the right vertebral artery. The child was diagnosed with dorsolateral medulla oblongata syndrome and was treated with gamma globulin to regulate immune function, with mannitol to reduce neuronal edema, with low-molecular-weight heparin sodium to improve local hypercoagulation of occluded blood vessels, with hyperbaric oxygen to improve local ischemia and hypoxia and promote the recovery of brain function, and with neuromuscular electrical stimulation to promote the recovery of neuromuscular function. Before discharge, only mild right ataxia and Horner syndrome remained. This article reports the first case of infantile dorsolateral medulla oblongata syndrome and provides experience for the diagnosis and treatment of the disease.


Subject(s)
Blepharoptosis/etiology , Child, Preschool , Dysarthria/etiology , Humans , Lateral Medullary Syndrome/diagnosis , Magnetic Resonance Imaging , Male , Medulla Oblongata/diagnostic imaging
5.
Audiol., Commun. res ; 25: e2264, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1131775

ABSTRACT

RESUMO A doença de Machado-Joseph é a forma de ataxia espinocerebelar de maior prevalência no Brasil e tem como alguns dos principais sinais clínicos a disfagia e a disartria. Este relato de caso objetivou verificar os efeitos da intervenção intensiva fonoaudiológica em um paciente com a doença de Machado-Joseph. A coleta de dados foi realizada a partir de protocolos de avaliação de fala e deglutição e protocolos de autoavaliação de qualidade de vida, em relação à deglutição e comunicação. Também foram realizadas avaliações quantitativas de parâmetros acústicos. A intervenção foi administrada por meio do método Lee Silverman, programa intensivo que visa ao aumento da intensidade vocal. A partir das avaliações clínicas e instrumentais, os resultados demonstraram melhora em todas as bases motoras de fala, respiratória, fonatória, ressonantal, articulatória e a prosódia, além da diminuição dos sinais disfágicos. Na qualidade vocal, houve diminuição de rouquidão e instabilidade, regularização de jitter e shimmer, aumento da intensidade vocal, melhora na coordenação de palavras e frases por expiração e, ainda, melhora discreta da diadococinesia. Após intervenção, a autoavaliação de qualidade de vida relacionada à deglutição apresentou valores iguais ou maiores nos domínios diretamente ligados à alimentação, porém, os domínios emocionais diminuíram. O paciente relatou satisfação em todos os domínios da qualidade de vida em voz e foram obtidos valores maiores em todos os domínios. Concluiu-se que a intervenção intensiva beneficiou o participante e impactou positivamente sua qualidade de vida.


ABSTRACT Machado-Joseph disease is the most prevalent form of spinocerebellar ataxia in Brazil, and has dysphagia and dysarthria among its main clinical signs. This case report aims to ascertain the effects of intensive speech-language intervention in a patient with Machado-Joseph disease. Data collection was performed based on speech and swallowing assessment protocols and self-assessment protocols specific to swallowing-related and communication-related quality of life. Quantitative assessments of acoustic parameters were also performed. The intervention was administered through the Lee Silverman method, which is an intensive program aimed at increasing vocal intensity. The results of clinical and instrumental evaluations showed improvement in all motor parameters of speech (respiration, phonation, resonance, articulation, and prosody), besides a reduction in dysphagic signs. Regarding vocal quality, there was a decrease in hoarseness and instability, regularization of jitter and shimmer, increased vocal intensity, and improved coordination of words and phrases by expiration, as well as slight improvement of diadochokinesis. After intervention, self-assessment of swallowing-related quality of life was unchanged or improved in the domains directly related to food, but reduced in emotional domains. The patient reported satisfaction in all domains of voice-related quality of life, and scores were increased in all domains. We conclude that intensive intervention was beneficial for the participant and positively impacted their quality of life.


Subject(s)
Humans , Male , Adult , Brazil/epidemiology , Deglutition Disorders , Machado-Joseph Disease/therapy , Machado-Joseph Disease/epidemiology , Dysarthria , Quality of Life , Voice Quality , Diagnostic Self Evaluation
6.
Revista Areté ; 20(2): 63-71, 2020. graf, tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1354762

ABSTRACT

Objetivo: Este estudio descriptivo se orientó a conocer el perfil clínico-epidemiológico de la Enfermedad de Parkinson (EP) y la coexistencia entre síntomas no motores (SNM) y diagnósticos fonoaudiológicos (DF). Método: La muestra estuvo conformada por 34 personas con Parkinson idiopático (26 hombres y 8 mujeres), cuyas historias clínicas fueron analizadas para describir la coexistencia de DF, como la hipofonía, la disprosodia, la disartria y la disfagia, con síntomas no motores, tales como: trastornos gastrointestinales, depresión, trastornos del sueño y deterioro cognitivo. Resultados: Los resultados señalan que las personas con Parkinson tenían edades entre los 25 a los 86 años. En cuanto a la fase, se clasificaron en: estadio I el 11,7%, II el 17,6%, III el 47%, IV el 14,7% y V el 8,8%. El 47% de los pacientes llegó al servicio de Fonoaudiología en una etapa avanzada de la EP. Los SNM más frecuentes fueron trastornos del sueño (67,6%), depresión (58,8%), alteraciones gastrointestinales (29,4%) y deterioro cognitivo (15%). Los DF se distribuyeron así: disprosodia (38%), hipofonía (33%), disartria (18%) y disfagia (11%). Discusión: se observa una alta frecuencia tanto de SNM (como la depresión y los trastornos del sueño), como de SF (especialmente disprosodia e hipofonía). Esta sintomatología provoca, por una parte, la reducción del deseo de relacionarse socialmente y por otro, dificultades para hacerse entender al presentar un volumen de voz reducido o prosodia (además de trastornos de la melodía, inflexiones, marcadores paralingüísticos) de la expresión oral del lenguaje. Conclusión: los trastornos del sueño y la depresión podrían tener un impacto negativo significativo en las funciones fonoaudiológico de las personas con Parkinson.


Objective: This descriptive study was aimed at understanding the clinical-epidemiological profile of Parkinson's disease (PD) and the coexistence between non-motor symptoms (NMS) and phonoaudiological diagnoses (PD). Methods: The sample comprised 34 people with idiopathic Parkinson's (26 men and 8 women). Their clinical histories were analysed to describe the coexistence of PD, such as hypophonia, dysprosody, dysarthria and dysphagia, with non-motor symptoms, such as gastrointestinal disorders, depression, sleep disorders and cognitive impairment. Results: The results indicate that people with Parkinson's are between the ages of 25 and 86. In terms of phase, they were classified as: stage I 11.7%, II 17.6%, III 47%, IV 14.7% and V 8.8%. 47% of patients reached the Speech Therapy service at an advanced stage of PD. The most frequent NMS were sleep disorders (67.6%), depression (58.8%), gastrointestinal disorders (29.4%) and cognitive impairment (15%). The PD were distributed as follows: dysprosody (38%), hypophonia (33%), dysarthria (18%) and dysphagia (11%). Discussion: a high frequency of both NMS (such as depression and sleep disorders) and PD (especially dysprosody and hypophonia) is observed. This symptomatology causes a reduction in the desire to relate socially, and difficulties in making oneself understood by presenting a reduced voice volume or prosody (in addition to melody of speech disorders, inflections, paralinguistic markers) of the oral language expression. Conclusion: sleep disorders and depression could have a significant negative impact on the speech and hearing functions of people with Parkinson's.


Subject(s)
Parkinson Disease , Speech, Language and Hearing Sciences , Language , Signs and Symptoms , Sleep Wake Disorders , Speech , Speech Disorders , Voice , Health Profile , Depression , Dysarthria
7.
Med. UIS ; 32(3): 49-54, Sep.-Dec. 2019. graf
Article in Spanish | LILACS | ID: biblio-1114976

ABSTRACT

Resumen La luxación temporomandibular es infrecuente, pero genera gran repercusión en el esqueleto facial. En ocasiones el cuadro clínico inicial es inespecífico y puede confundirse con otras patologías si no se tiene un adecuado conocimiento del tema, o se realiza una anamnesis incorrecta. Este artículo presenta el caso de una paciente que consultó al servicio de urgencias por disartria y desviación de la comisura labial hacia la izquierda, asociado a dolor severo y parestesia en hemicara derecha. No obstante, al ingreso la paciente refirió síntomas ambiguos, que para el médico evaluador sugirieron una causa neurológica. Durante la observación se solicitó valoración por servicio de cirugía plástica, se logró orientación de la anamnesis y examen físico, obteniendo una impresión diagnóstica de luxación de articulación temporomandibular derecha, confirmada por imagenología, y por ende un tratamiento oportuno con reducción e inmovilización en el servicio de urgencias. MÉD.UIS.2019;32(3):49-54


Abstract The temporomandibular joint dislocation is uncommon, but it causes a great repercussion on the facial skeleton. Occasionally, the initial symptoms can be unspecific and confuse with other pathologies if there are not an adequate knowledge of the topic and the anamnesis is incorrect. This article presents a clinical case of a patient with dysarthria and left deviation of the labial commissure, associated with severe pain and paresthesia in the right side of the face. Nevertheless, the patient initially referred ambiguous symptoms, suggesting a neurological cause. During observation in the emergency room, plastic surgery service valorated the patient, with subsequent orientation of the anamnesis and physical examination, achieving a satisfactory management of the acute dislocation. MÉD.UIS.2019;32(3):49-54


Subject(s)
Humans , Female , Adult , Temporomandibular Joint Disorders , Joint Dislocations , Pain , Paresthesia , Pathology , Physical Examination , Printing , Skeleton , Surgery, Plastic , Temporomandibular Joint , Dysarthria , Face , Immobilization , Medical History Taking
8.
Rev. bras. neurol ; 55(4): 10-12, out.-dez. 2019.
Article in English | LILACS | ID: biblio-1095492

ABSTRACT

For many years, the cerebellum was thought to be only responsible for balance, movement, planning and execution. Nowadays, it is well accepted that most cerebellar connections are involved in non-motor functions. Herein, we provide a case report in which a 27-year-old Brazilian male, diagnosed with Obsessive-Compulsive Disorder (OCD), has demonstrated cerebellar features that could be connected to Spinocerebellar ataxia type 1 (SCA-1), an autosomal dominant polyglutamine neurodegenerative disorder that had been previously ruled out. Since obsessive compulsive symptoms (OCS) are known to correlate with alterations in the cortico-striato-thalamo-cortical circuitry, we propose a possible association between OCS and SCA onset.


Durante muitos anos, o cerebelo foi considerado responsável exclusivamente pelo controle das funções de equilíbrio, movimento, planejamento e execução. Atualmente, já está consagrada a participação das conexões cerebelares em funções não-motoras. Apresentamos um relato de caso de um paciente de 27 anos de idade, diagnosticado com Transtorno Obsessivo-Compulsivo (TOC). O paciente apresentava sintomas cerebelares compatíveis com o diagnóstico de ataxia espinocerebelar tipo 1 (SCA-1), um distúrbio da poliglutamina, autossômico dominante neurodegenerativo, que havia sido previamente descartado. Como os sintomas obsessivos compulsivos (SOC) são conhecidos por correlacionar-se com alterações nos circuitos cortico-estriato-tálamo-cortical, propomos uma possível associação entre o SOC e o início da SCA.


Subject(s)
Humans , Male , Adult , Spinocerebellar Ataxias/complications , Spinocerebellar Ataxias/diagnosis , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/therapy , Genetic Testing , Gait Ataxia , Dysarthria , Ataxin-1/genetics , Neurologic Examination/methods
9.
Audiol., Commun. res ; 24: e2118, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1038755

ABSTRACT

RESUMO Este estudo descreveu o processo de avaliação das bases motoras e de intervenção, conduzido através da hierarquia do tratamento motor da fala em uma pessoa do sexo masculino, de 45 anos, que possui disartria flácida decorrente de acidente vascular encefálico. O paciente recebeu tratamento fonoaudiológico após três anos da lesão cerebral, dividido em 25 sessões semanais, que ocorreram durante oito meses. Foram realizadas avaliações fonoaudiológicas pré e pós terapia, bem como após cada período de tratamento de uma base motora. A terapia obedeceu à hierarquia do tratamento motor da fala, iniciando pela reabilitação da respiração, ressonância e prosódia, seguindo para terapia da fonação e, por último, ajustes da articulação. O paciente apresentou aperfeiçoamento em todas as bases motoras, adquirindo adequado suporte respiratório e ressonância durante a fala, melhorias na prosódia e precisão articulatória e mais estabilidade vocal. Além disso, quanto à autopercepção do paciente, em relação aos progressos terapêuticos, este relatou diminuição dos impactos da disartria na sua qualidade de vida. Sendo assim, foram evidenciados os benefícios do tratamento fonoaudiológico na disartria, principalmente ao seguir a estrutura proposta pela hierarquia do tratamento motor da fala. Os resultados permitiram concluir que uma adequada abordagem terapêutica pode proporcionar ganhos, mesmo alguns anos após a lesão cerebral.


ABSTRACT This study described the motor speech bases assessment and therapeutic process conducted through the hierarchy of motor speech treatment in a 45-year-old person, male, that has flaccid dysarthria caused by stroke. This patient received speech-language therapy after three years since the brain lesion, during 25 weekly sessions that occurred in 8 months. Speech-language assessments were applied before and after therapy, as well as a specific evaluation after each base motor treatment. Therapy obeyed the hierarchy of motor speech treatment, initiating with respiratory and resonance rehabilitation, following by prosodic therapy, phonatory treatment and, lately, articulatory treatment. The patient showed improvements in all motor speech bases, acquiring adequacy in respiratory support and resonance during the speech, improvements in prosody, more articulatory precision, and vocal stability. Beyond that, about patient self-perception about therapeutic progressions, he related reduction of the dysarthria impacts in his life quality. In this way, the benefits of speech-language therapy in dysarthria had been evidenced, mainly at following the proposal of the hierarchy of motor speech treatment structure. Results allowed us to conclude that an appropriate therapeutic approach may offer benefits even years after cerebral lesion.


Subject(s)
Humans , Male , Middle Aged , Articulation Disorders/therapy , Speech Therapy , Brain Injuries/rehabilitation , Dysarthria/therapy , Quality of Life , Stroke , Neuromuscular Diseases
10.
Audiol., Commun. res ; 24: e2008, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1019479

ABSTRACT

RESUMO Objetivo Verificar o efeito imediato e após 15 minutos da técnica de sobrearticulação de fala em indivíduos com doença de Parkinson, submetidos à estimulação cerebral profunda em núcleo subtalâmico, nos parâmetros de voz, fala e mímica facial. Métodos Participaram 29 sujeitos com diagnóstico médico de doença de Parkinson, sob tratamento medicamentoso e submetidos à estimulação cerebral profunda em núcleo subtalâmico, com e sem reabilitação fonoaudiológica prévia. Realizou-se gravação em áudio e vídeo de amostra de fala e voz em três momentos: pré-intervenção, pós-imediato e após 15 minutos da realização individual de cinco minutos de uma sequência de exercícios de sobrearticulação de fala. As gravações foram submetidas à avaliação perceptivo-auditiva da voz e perceptivo-visual da mímica facial. Resultados A técnica produziu resultados positivos em 69% dos casos, após 15 minutos de aplicação, em relação aos demais momentos. O parâmetro que mais contribuiu para a identificação da melhor emissão na avaliação perceptivo-auditiva foi articulação (69%), significativamente maior que os demais parâmetros, exceto velocidade de fala. A análise perceptivo-visual mostrou melhora em 58,6% dos casos após 15 minutos, também significativamente melhor que os demais momentos. O parâmetro em que se observou maior proporção de melhora foi na movimentação de boca, sobrancelhas e olhos. Conclusão A técnica de sobrearticulação de fala produz efeito positivo imediato nos aspectos vocais e uma maior expressividade facial, principalmente após 15 minutos de realização.


ABSTRACT Purpose To verify the immediate and after 15 minutes effect of the overarticulation technique in individuals with Parkinson's disease, submitted to deep brain stimulation in subthalamic nucleus, in the voice, speech and facial movements. Methods This study counted with 29 patients with the diagnosis of Parkinson Disease who were undergoing pharmacotherapy and were submitted to deep brain stimulation in the subthalamic nucleus, with and without prior speech therapy. Speech and voice samples were recorded in an audio and video file at three different moments: pre-intervention, immediate post intervention and 15 minutes post intervention. The intervention was the individual performance of 5 minutes exercise consisting of sequence of overarticulation techniques. The audio and video recordings were submitted to the perceptual-judgement of the voice quality and facial movements. Results The technique produced positive results in 69% of the cases after 15 minutes of its application when compared to the other moments. Articulation was the parameter that most contributed in the perceptual-judgment of the best voice quality (69%); it was significantly higher than the other parameters, except speech rate. After 15 minutes of the technique, 58.6% of the patients had improvement in the facial movements, according to the perceptual-judgment which was also significantly better when compared to other moments. The parameter with greater provement was movement of the mouth, eyebrows and eyes. Conclusion The overarticulation technique produces an immediate positive effect on vocal aspects and greater facial expressiveness, especially after 15 minutes.


Subject(s)
Humans , Parkinson Disease/therapy , Speech Therapy/methods , Voice Disorders/rehabilitation , Deep Brain Stimulation , Dysarthria/rehabilitation , Parkinson Disease/surgery , Prospective Studies , Hypokinesia/rehabilitation , Subthalamic Nucleus/surgery , Facial Expression
11.
Article in English | WPRIM | ID: wpr-764939

ABSTRACT

BACKGROUND: The gold standard in dysarthria assessment involves subjective analysis by a speech–language pathologist (SLP). We aimed to investigate the feasibility of dysarthria assessment using automatic speech recognition. METHODS: We developed an automatic speech recognition based software to assess dysarthria severity using hidden Markov models (HMMs). Word-specific HMMs were trained using the utterances from one hundred healthy individuals. Twenty-eight patients with dysarthria caused by neurological disorders, including stroke, traumatic brain injury, and Parkinson's disease were participated and their utterances were recorded. The utterances of 37 words from the Assessment of Phonology and Articulation for Children test were recorded in a quiet control booth in both groups. Patients were asked to repeat the recordings for evaluating the test–retest reliability. Patients' utterances were evaluated by two experienced SLPs, and the consonant production accuracy was calculated as a measure of dysarthria severity. The trained HMMs were also employed to evaluate the patients' utterances by calculating the averaged log likelihood (aLL) as the fitness of the spoken word to the word-specific HMM. RESULTS: The consonant production accuracy reported by the SLPs strongly correlated (r = 0.808) with the aLL, and the aLL showed excellent test–retest reliability (intraclass correlation coefficient, 0.964). CONCLUSION: This leads to the conclusion that dysarthria assessment using a one-word speech recognition system based on word-specific HMMs is feasible in neurological disorders.


Subject(s)
Brain Injuries , Child , Dysarthria , Humans , Nervous System Diseases , Parkinson Disease , Stroke
12.
Article in English | WPRIM | ID: wpr-764376

ABSTRACT

BACKGROUND AND PURPOSE: Neurological involvement in Behçet's disease [neuro-Behçet's disease (NBD)] is uncommon, but it is worth investigating since it can cause substantial disability. However, difficulties exist in understanding the clinical features of NBD due to regional variations and the lack of studies utilizing well-established diagnostic criteria. We therefore analyzed the clinical features of patients with NBD based on the recent international consensus recommendation. METHODS: We retrospectively searched electronic databases for patients with Behçet's disease (BD) between 2000 and 2017, and reviewed their medical records. Based on the recent international consensus recommendation, patients with definite or probable NBD were included. RESULTS: Of 9,817 patients with the diagnosis code for BD, 1,682 (17.1%) visited the neurology clinic and 110 (1.1%) were classified as NBD. Ninety-eight patients exhibited parenchymal NBD and 12 exhibited nonparenchymal NBD. Their age at the onset of NBD was 37.6±10.6 years and the male-to-female ratio was 1.24:1. Brainstem syndrome (43.9%) was the most common condition in the 98 patients with parenchymal NBD, followed by multifocal (32.7%) and spinal cord (12.2%) syndromes. 72.4% exhibited acute NBD and 27.6% exhibited a progressive disease course. Frequent manifestations included pyramidal signs (52.0%), headache (45.9%), dysarthria (42.9%), and fever (31.6%). A frequent pattern in brain MRI was an upper brainstem lesion extending to the thalamus and basal ganglia. CONCLUSIONS: Approximately 1% of the patients with suspected BD exhibited NBD. Neurologists must understand the clinical characteristics of NBD in order to perform the differential diagnosis and management of these patients.


Subject(s)
Basal Ganglia , Brain , Brain Stem , Classification , Consensus , Diagnosis , Diagnosis, Differential , Dysarthria , Fever , Headache , Humans , Korea , Magnetic Resonance Imaging , Medical Records , Neurology , Retrospective Studies , Spinal Cord , Thalamus
13.
Article in English | WPRIM | ID: wpr-739819

ABSTRACT

We describe a 33-year-old woman with chronic bulbar dysarthria after ischemic brainstem stroke who underwent a new form of constraint-induced therapy, namely constraint-induced dysarthria therapy, based on three principles: avoidance of supportive devices, intensive therapy, and gradually augmenting difficulty. After a 2-month intervention, improvement was noted for speech intelligibility, fluency, and intensity. This led to increased communicative participation, including during conversation situations, which has been maintained over a 12-month follow-up.


Subject(s)
Adult , Brain Stem Infarctions , Dysarthria , Female , Follow-Up Studies , Humans , Speech Intelligibility , Stroke
14.
Article in English | WPRIM | ID: wpr-739666

ABSTRACT

Supratentorial extraventricular anaplastic ependymoma (SEAE) in adults is a relatively rare intracranial tumor. Because of the very low prevalence, only a few cases have been reported. According to a recent study, SEAE is associated with a poor prognosis and there is no definite consensus on optimal treatment. We report a case of an adult SEAE patient who had no recurrence until seven years after a gross total resection (GTR) followed by conventional radiotherapy. A 42-year-old male had a persistent mild headache, left facial palsy, dysarthria, and left hemiparesis. Preoperative neuroimaging revealed an anaplastic astrocytoma or supratentorial ependymoma in the right frontal lobe. A GTR was performed, followed by adjuvant radiotherapy. Histologic and immunohistochemical results revealed anaplastic ependymoma. After seven years of initial therapy, a regular follow-up MRI showed a 3-cm-sized partially cystic mass in the same area as the initial tumor. The patient underwent a craniotomy, and a GTR was performed. Histopathologic examination revealed recurrence of the SEAE. External radiotherapy was performed. The patient has been stable without any disease progression or complications for 12 months since the surgery for recurrent SEAE.


Subject(s)
Adult , Astrocytoma , Consensus , Craniotomy , Disease Progression , Dysarthria , Ependymoma , Facial Paralysis , Follow-Up Studies , Frontal Lobe , Headache , Humans , Magnetic Resonance Imaging , Male , Neuroimaging , Paresis , Prevalence , Prognosis , Radiotherapy , Radiotherapy, Adjuvant , Recurrence , Supratentorial Neoplasms
15.
Yonsei Medical Journal ; : 1112-1115, 2019.
Article in English | WPRIM | ID: wpr-762046

ABSTRACT

Direct puncture and embolization of the transverse sinus (TS) for treatment of dural arteriovenous fistula (DAVF) is typically performed with coils with or without glue. We report a case of DAVF at the left TS that was treated with Onyx embolization via direct puncture of the TS. A 75-year-old woman presented with tremor, festinating gait, and dysarthria. A left TS-DAVF with retrograde superior sagittal sinus and cortical venous reflux (Cognard type IIa+b) was identified on cerebral angiography, and both TSs were occluded with thrombi. We considered that achieving complete cure by transvenous embolization via the femoral vein or transarterial embolization via occipital feeders would be difficult. Thus, we performed a small craniotomy at the occipital bone to puncture the TS. The midportion of the TS was directly punctured with a 21-G microneedle under fluoroscopic guidance. We inserted a 5-F sheath into the TS. A microcatheter was then navigated into the affected sinus. Coils were placed through the microcatheter to support Onyx formation by reducing the pressure of shunting flow. Onyx embolization was performed with the same microcatheter. The DAVF was almost completely occluded except for the presence of minimal shunting flow to the proximal TS. After 1 week, time-of-flight magnetic resonance angiography showed complete resolution of DAVF. The patient showed resolved tremor and markedly improved mental status at 1-month follow up. Direct puncture and embolization of the TS using coils and Onyx is effective and feasible method for the treatment of DAVF when other approaches seem difficult.


Subject(s)
Adhesives , Aged , Central Nervous System Vascular Malformations , Cerebral Angiography , Craniotomy , Dysarthria , Female , Femoral Vein , Follow-Up Studies , Gait Disorders, Neurologic , Humans , Magnetic Resonance Angiography , Methods , Occipital Bone , Punctures , Superior Sagittal Sinus , Tremor
16.
Article in English | WPRIM | ID: wpr-761754

ABSTRACT

A complicated case of echinococcosis with multiple organ involvement is reported in a 53-year-old businessman who frequently traveled overseas, including China, Russia, and Kazakhstan from 2001 to 2007. The patient was first diagnosed with a large liver cyst during a screening abdomen ultrasonography in 2011, but he did not follow up on the lesion afterwards. Six years later, dizziness, dysarthria, and cough developed, and cystic lesions were found in the brain, liver and lungs. The clinical course was complicated when the patient went through multiple surgeries and inadequate treatment with a short duration of albendazole without a definite diagnosis. The patient visited our hospital for the first time in August 2018 due to worsening symptoms; he was finally diagnosed with echinococcosis using imaging and serologic criteria. He is now on prolonged albendazole treatment (400 mg twice a day) with gradual clinical and radiological improvement. A high index of suspicion is warranted to early diagnose echinococcosis in a patient with a travel history to endemic areas of echinococcosis.


Subject(s)
Abdomen , Albendazole , Brain , China , Cough , Diagnosis , Dizziness , Dysarthria , Echinococcosis , Follow-Up Studies , Humans , Kazakhstan , Korea , Liver , Lung , Mass Screening , Middle Aged , Russia , Ultrasonography
17.
Article in Korean | WPRIM | ID: wpr-761457

ABSTRACT

A patient who went through maxillectomy can have soft palate defects including oronasal fistulas and suffer from dysphagia and dysarthria due to velopharyngeal insufficiency. This defect causes the food to enter nasal cavity and creates hypernasal sound which debilitates a quality of life. An obturator can rehabilitate the substantial oral tissue defects. The maxillary obturator separates the nasopharynx from the oropharynx during speech and deglutition by closing of the defect. For edentulous obturator patient, it is difficult to obtain proper retention due to reduced peripheral sealing. Therefore, the contours of the defects must be used to maximize the retention, stability, and support. Hollow type obturator can improve physiologic function by reducing weight than the traditional obturator. This case report describes a patient with hemi-maxillectomy who recovers mastication, speech, deglutition, and appearance with a maxillary obturator using physiological border molding of the velopharyngeal area and double-processing method.


Subject(s)
Deglutition , Deglutition Disorders , Dysarthria , Fistula , Fungi , Humans , Mastication , Maxillofacial Prosthesis , Methods , Nasal Cavity , Nasopharynx , Oropharynx , Palatal Obturators , Palate, Soft , Quality of Life , Rehabilitation , Velopharyngeal Insufficiency
18.
Article in Chinese | WPRIM | ID: wpr-775906

ABSTRACT

OBJECTIVE@#To systematically evaluate the clinical efficacy of acupuncture for dysarthria, and to explore the rules of acupoints selection for dysarthria.@*METHODS@#The clinical randomized control trial literature regarding acupuncture for dysarthria published before January of 2018 were searched in databases, including CNKI, Wanfang, VIP, CBM, PubMed, Ebsco, Science Direct and Cochrane Library. The information of included studies was extract and the quality was assessed. The Meta analysis was performed by using RevMan 5.3 software. The frequency of acupoints was calculated by using Excel software to analyzed the rules of acupoints selection.@*RESULTS@#Totally 21 papers were included, involving 1651 patients. The pooled effects of clinical efficacy: heterogeneity test =0.74, =0%, =6.36, 95% CI: 4.55, 8.88, =10.84 (<0.01), indicating the efficacy in the treatment group was significantly higher than that in the control group. The pooled effects of the symptom score in Frenchay scale: heterogeneity test =0.56, =0%, =3.20, 95% CI: 1.38, 5.02, =3.45 (<0.01), indicating the efficacy in the treatment group was significantly higher than that in the control group. The acupoints with frequency of more than 5 times were Fengchi (GB 20), Yuye (EX-HN 13), Jinjin (EX-HN 12), Lianquan (CV 23), Baihui (GV 20), tongue-three needles and Yamen (GV15). The meridians with frequency of more than 5 times were the extra channels, governor vessel, gallbladder channel, conception vessel and stomach channel.@*CONCLUSION@#The clinical efficacy of acupuncture combined with speech training/regular treatment is significantly superior to that of control group (speech training, medication, regular treatment); acupuncture is safe and effective for dysarthria; the majority of selected acupoint is local acupoints around tongue, throat and neck, as well as extra points and empirical points. However, high-quality randomized controlled trials with large sample sizes are still needed to provide further evidence.


Subject(s)
Acupuncture Therapy , Dysarthria , Therapeutics , Humans , Meridians , Speech Therapy
19.
Article in English | WPRIM | ID: wpr-762794

ABSTRACT

Macroglossia is a rare clinical condition defined as an enlarged tongue. Macroglossia can cause structural deformities like diastema and disproportionate mandibular growth and present functional disorders such as dysarthria, dysphonia, and respiratory problems. A 7-year-old boy who had lymphangiomatous macroglossia was treated with a reduction glossectomy by anchor-shaped combination of a U-shape and modified key-hole resection. Postoperatively, the reduced tongue was contained completely within the oral cavity, but open bite remained due to prognathism. Sensory and motor nerves to the tongue appeared to be intact, and circulation was adequate. This patient will be monitored for recurrence of tongue enlargement.


Subject(s)
Child , Congenital Abnormalities , Diastema , Dysarthria , Dysphonia , Glossectomy , Humans , Lymphangioma , Macroglossia , Male , Mouth , Open Bite , Prognathism , Recurrence , Tongue
20.
Rev. med. Rosario ; 84(2): 67-70, mayo-ago. 2018. tab
Article in Spanish | LILACS | ID: biblio-1050943

ABSTRACT

El cáncer de páncreas resulta una de las patologías oncológicas con mayor índice de mortalidad en Argentina. Dadala importancia y prevalencia de esta afección, en los últimos años se han desarrollado varias alternativas de tratamiento que incluyen cirugía, radioterapia y quimioterapia endovenosa. El FOLFIRINOX es uno de los esquemas dequimioterapia de primera línea en los casos de neoadyuvancia y tumores avanzados. El esquema incluye dos drogasneurotóxicas: Oxaliplatino e Irinotecán. Se presentan dos casos de neurotoxicidad orofaríngea durante la infusiónde quimioterapia: un paciente masculino de 38 años y una femenina de 54. En ambos casos la neurotoxicidad fuereversible espontáneamente. Se plantea la disminución de la velocidad de infusión de oxaliplatino y la separación dela administración de ambas drogas como estrategia para la disminución de los efectos adversos(AU)


Pancreatic cancer is one of the oncological pathologies with the highest mortality rate in Argentina. Given the prevalenceof this condition, several treatments have been developed, including surgery, radiotherapy and intravenous chemotherapy.FOLFIRINOX is one of the first-line chemotherapy schemes in cases of neoadjuvant and advanced tumors. The schemeincludes two highly neurotoxic drugs: Oxaliplatin and Irinotecan. We present two cases of oropharyngeal neurotoxicityduring the chemotherapy infusion. A 38 years old male patient and 54 years old female patient. In both cases theoropharyngeal neurotoxicity was spontaneously reversible. The decrease in the rate of infusion of oxaliplatin and theseparation of the administration of both drugs was the strategy for the reduction of adverse effects(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pancreatic Neoplasms/drug therapy , Neurotoxicity Syndromes , Pancreatic Neoplasms/therapy , Drug Therapy , Drug-Related Side Effects and Adverse Reactions , Dysarthria
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