Mixed Dysarthrias Flashcards
1
Q
Why are mixed dysarthrias common?
A
THe damage that causes dysarthrias often affects more than one area or system.
2
Q
What is the most common dysarthria according to one of the figures in the book?
A
mixed dysarthria
3
Q
You can have a combination of ___ or more of these pure dysarthrias?
A
2
4
Q
Which component dominates in mixed dysarthrias?
A
The first name given
5
Q
Why is it important to determine the types of mixed dysarthrias and the components?
A
It may help rule our or confirm neurological diagnoses.
6
Q
What are the etiologies of mixed dysarthria?
A
commonly caused by more than one event. multiple strokes, combination of neurological or degenerative diseases such as PD and stroke, chorea and stroke
-often seen in degenerative diseases
7
Q
Mixed dysarthria is often seen in ______ diseases.
A
degenerative
8
Q
What are the types of mixed dysarthrias and precentages in Duffy’s practice?
A
- Ataxic-flaccid-spastic: 6%
- Hypokinetic-spastic 7%
- Other mixes: 19%
- Ataxic-spastic: 23%
- Hyperkinetic-hypokinetic: 35%
- Flaccid-spastic: 42%
9
Q
What is the most common etiology of mixed dysarthrias?
A
degenerative diseases
10
Q
Name the different degenerative diseases that can cause mixed dysarthria?
A
1-motor neuron disease 2- multiple sclerosis 3-Frederich's Ataxia 4- Progressive Supranuclear Palsy 5- Multiple Systems Atrophy 6- Corticobasal degeneration
11
Q
what are the different motor neuron diseases that can cause mixed dysarthria?
A
-ALS: bulbar or spinal
-Primary lateral sclerosis
-
12
Q
What is the most common motor neuron disease that causes mixed dysarthria?
A
ALS: amyotrophic lateral sclerosis
13
Q
What is amyotrophic lateral sclerosis (ALS)
A
Has both UMN and LMN involvement. Commonly has mixed spastic-flaccid or flaccid-spastic components. It can be hard to diagnose. Nearly always fatal. Most die between 2 to 5 years after diagnosis. Some few live more than 12 years. Death usually due to respiratory failure - but person can be put on ventilator.
14
Q
ALS occurs in ___ to ___ per 100,000.
A
1-5
15
Q
Who is affected more by ALS?
A
men
16
Q
_____ of ALS is familial.
A
5%
17
Q
What is the onset for people with ALS?
A
Between 40- 70 years
18
Q
When do most people with ALS die?
A
between 2 to 5 years after diagnosis. SOme few live more than 12 years.
19
Q
What do people with ALS usually die from?
A
respiratory failure
20
Q
ALS can be _____ or ______.
A
bulbar
spinal
21
Q
Patients with ______ ALS onset have ______ and _____ problems very early on.
A
bulbar
speech
swallowing
22
Q
Patients with spinal onset have problems with _____ first.
A
limbs
23
Q
Patiens with bulbar ALS onset have what king of problems very early on?
A
speech and swallowing
24
Q
How is a diagnosis of ALS confirmed?
A
EMG findings of weakness
25
What is primary lateral sclerosis (PLS)?
Affects UMN only. It may be hard to distinguish from ALS. It typically produces spastic dysarthria but is hard to differentiate from ALS.
26
________ is hard to differentiate from ALS.
Primary lateral sclerosis (PLS)
27
Primary lateral sclerosis typically produces what type of dysarthria?
spastic
28
What is spinal muscle atrophies?
Affects LMN only - progressive limb wasting and weakness - may have some cranial nerve weakness as well. It is a motor neuron disease but typically produced only flaccid dysrthria. not mixed.
29
What does primary lateral sclerosis affect?
UMN only
30
What does spinal muscle atrophies affect?
LMN only
31
What is progressive bulbar palsy?
Primarily has LMN weakness of cranial nerve muscles. Dysarthria and dysphagia predominate. Similar to ALS without limb involvement. It is usually associated with flaccid dysarthria, not mixed.
32
Bulbar palsy has primarily _____ weakness of cranial nerve muscles.
LLMN
33
______ and ______ predominate with bulbar palsy.
Dysarthria and dysphagia
34
Bulbar palsy is usually associated with ______ dysarthria.
flaccid
35
What is multiple sclerosis?
It is a demyelination disease - the myelination is attacked but the axon itself is not. It is the most common CNS disease affecting young and middle age adults between 20 to 40 years of age. It affects more women than men. Cause is unknown - may be related to autoimmune cause triggered by environmental and genetic interactions. Diagnosis is difficult- MRI often used for diagnosis.
36
What is the most common CNS disease affecting young and middle age adults between the ages of 20-40.
Multiple sclerosis
37
Multiple sclerosis affects more _____.
women
38
What is the cause of multiple sclerosis?
Cause is unknown - may be related to autoimmune cause triggered by environmental and genetic interactions.
39
It is difficult to diagnose multiple sclerosis but _____ is often used for diagnosis.
MRI
40
What can be the course of multiple sclerosis?
- Benign: only few episodes, then remission
- Relapsing-remitting - comes and goes
- Remitting-progressive -comes and goes but progressively gets worse
- Progressive: no remission
41
Patients with multiple sclerosis often exhibit problems with _____ and other _____ difficulties and some ______ deficits. _______ is not common.
vision
sensory
cognitive
dysphagia
42
What are the problems that patients with multiple sclerosis exhibit?
vision, sensory, cognitive
43
What is the most common type of mixed dysarthria for patients with multiple sclerosis?
Ataxic-spastic, but any combination can occur
44
In multiple sclerosis, the type of dysarthria is more _____ than with other diseases.
unpredictable
45
What is Frederich's ataxia?
Is associated with cerebellar dysfunction, but can also be associated with mixed spastic/ataxic dysarthria
46
What is progressive supranuclear palsy?
It's a neurodegenerative disease associated with multisystem involvement. May be confused with PD because it has similar symptoms such as bradykinesia. Dysphagia and dysarthria are common and are evidenced early on in the disease. Mixed dysarthrias seen in this disease are combinations of hypokinetic, spastic, and ataxic.
47
_______ _______ is associated with cerebellar dysfunction, but can also be associated with mixed spastic/ataxic dysarthria/
Frederich's ataxia
48
Frederich's ataxia can be associated with _______ dysfunction, but can also be associated with mixed _______ dysarthria.
cerebellar
| spastic/ataxic
49
____ _____ ______ is a neurodegenerative disease associated with multisystem involvement. May be confused with PD because it has similar symptoms such as bradykinesia.
Progressive Supranuclear palsy
50
Dysphagia and dysarthria are common and are common and are evidenced early on in _____ ________. It may also be confused with PD.
multiple sclerosis
51
Mixed dysarthrias seen in _____ _______ are combinations of hypokinetic, spastic and ataxic.
multiple sclerosis
52
Multiple sclerosis may be comfused with ____ because it has similar symptoms such as bradykinesia.
PD
53
What is multiple systems atrophy?
It is similar to progressive supranuclear palsy and Parkinson's disease, but doesn't respond well to L-Dopa.
54
Shy drager syndrome falls under ______ ____ ______ diseases.
Multiple systems atrophy
55
What are the types of mixed dysarthrias in multiple systems atrophy?
-hypokinetic,
-hyperkinetic
-ataxic
-spastic
depending underlying pathologies
56
What is shy-drager syndrome?
Is a progressive neurologic disease-unknown etiology. First signs are usually blood pressure problems when standing, incontinence and decreased respiration and impotence. May also have problems with gait, dysarthria and dysphagia. Most common types of dysarthria associated with SDS are hypokinetic, ataxic, spastic, and flaccid.
57
What are the first signs of shy-drager syndrome?
Blood pressure problems when standing
- incontinence
- decreased respiration and impotence
- may also have problems with gait
- dysarthria
- and dysphagia
58
What are the most common types of dysarthria associated with shy drager syndrome?
- hypokinetic
- ataxic
- spastic
- flaccid
59
What is corticobasal degeneration?
It is rare and involved impairment of cortex and basal ganglia. It presents most often with spastic-hypokinetic dysarthria, but can have ataxic and hyperkinetic components.
60
What mixed dysarthrias present with corticobasal degeneration?
It presents most often with spastic-hypokinetic dysarthria, but can have ataxic and hyperkinetic components.
61
What are the effects of toxic metabolic conditions?
Effects tend to be diffuse and damage can impair several components, thus resulting in a mixed dysarthria.
62
What are two toxic metabolic conditions that can cause mixed dysarthria?
- Wilson's diseases
| - Hypoxic encephalopathy
63
What is Wilson's disease?
It is a metabolic disorder leading to too much copper in brain, eyes, and liver, It can be fatal. It often demonstrates brown rings around cornea of the eyes. Dysarthria is predominant symptom- and typically involves two or more of these: hypokinetic, ataxic, and spastic.
64
______ _______ is a metabolic disorder leading to too much copper in brain, eyes, and liver. It can be fatal.
Wilson's disease
65
How does Wilson's disease present itself?
Demonstrates brown rings around cornea of the eyes.
66
What is the predominant symptom of Wilson's disease?
Dysarthria- typically involves two or more of these: hypokinetic, ataxic, and spastic.
67
What is hypoxic encephalopathy?
Due to lack of oxygen to brain because of heart and lung problems. With loss of oxygen, brain damage occurs. Mixed dysarthrias often occur involving hypokinetic, hyperkinetic and ataxic dysarthrias.
68
What are the mixed dysarthrias that happen often with hypoxic encephalopathy?
hypokinetic
hyperkinetic
ataxic
69
______ _______ happens due to lack of oxygen to brain because of heart and lung problems. With loss of oxygen, brain damage occurs.
Hypoxic encephalopathy
70
How can vascular disorders cause mixed dysarthria?
Multiple strokes often affect multiple systems and produce mixed dysarthrias of any combination. If strokes affect brain stem, dysarthria may include flaccid, spastic, and ataxic due to close proximity of pyramidal and extrapyramidal fibers.
71
If strokes affect brain stem, dysarthria may include what?
Flaccid, spastic, and ataxic due to close proximity of pyramidal and extrapyramidal fibers.
72
______ can produce any combination of dysarthrias.
TBI
73
______ dysarthria is more common with TBI than single dysarthrias due to the diffuse injuries associated with TBI.
Mixed
74
Mixed dysarthrias is more common with _____ than single dysarthrias.
TBI
75
Why is a mixed dysarthria more common with TBI than single dysarthrias?
Due to the diffuse injuries associated with TBI
76
Why do tumors produce various mixed dysarthrias?
Tumors affect various components of neurological system.
77
______ is a good example of infectious and autoimmune diseases than can produce various mixed dysarthrias.
AIDS
78
What does the type of dysarthria depend on with AIDS?
It depends on the condition that is presenting with AIDS.
79
What is the first symptom/sign of ALS?
dysarthria
80
What happens to speech intelligibility on a patient with ALS?
- The majority are unintelligible by the time death occurs.
- Most need AAC intervention within approximately 3 years of diagnosis and use them about 2 years before death.
- Intelligibility can be severely affected due to hypernasality, reduced ability to build up intraoral air pressure and weakness of tongue.
81
Can dysarthria be mixed throughout the entire disease?
Dysarthria may not be mixed throughout the entire disease.
82
Why is intelligibility severely affected in patients with ALS?
Intelligibility can be severely affected due to hypernasality, reduced ability to build up intraoral air pressure and weakness of tongue.
83
Dysarthria in ALS has what type of components when it is mixed?
flaccid and spastic and either of those can predominate
84
In ALS symptoms of flaccid and spastic can occur. What can occur with spasticity?
Pathological reflexed and pseudobulbar effect can occur
85
In ALS symptoms of flaccid and spastic can occur? What can occur with flaccidity?
Fasciculations and atrophy can occur
86
What are other symptoms that can also occur in ALS that aren't seen with single dysarthrias?
- Tremor or flutter in voice is commonly seen, especially in vowel prolongation (the cause is not known)
- wet or gurgly voice-due to turbulence in voice from saliva that builds up in pyriform sinuses and on vocal folds due to reduced swallowing and clearing of secretions.
87
Why does wet or gurgly voice happen in ALS?
Due to turbulence in voice from saliva that builds up in pyriform sinuses and on vocal folds due to reduced swallowing and clearing of secretions.
88
Study cases of :
Mixed dysarthrias
89
Spinal muscle atrophies usually produces only ______ dyasrthria.
flaccid
90
Progressive bulbar palsy is usually associated with ______ dysarthria.
flaccid
