Speech Flashcards
Where in the brainstem do you find the bulbar nerves?
Medulla (used to be called ‘the bulb of the spine’, hence the name of the nerves)
What do you look for when inspecting for the hypoglossal nerve (CN XI)?
Palatial asymmetry and uvula deviation- if present are away from lesion
What are you listening for when you assess a patient’s speech in a CN exam?
- Quality
- Volume (hoarseness, quietness)
What cranial nerves are responsible for controlling speech and swallow?
The bulbar nerves- CN IX, X, XI and XII (Glossopharyngeal, vagus, accessory and hypoglossal)
What is dysphonia?
Impaired production of voice sounds due to impaired ability to produce voice sounds using the vocal organs (mouth, tongue, throat or vocal cords) E.g. hoarse, breathy, harsh, rough
What is dysarthria?
- Disorder of speech.
- Impaired articulation due to dysfunction of the muscles needed to produce speech in the tongue, lips, mouth or NM pathway disruption.
- There is no problem in understanding cognitive language.
What is dysphasia?
Disorder of language
How do you test for dysarthria?
- Repetition of phrases:
- “Yellow lorry”- tests lingual sounds
- “Baby hippopotamus”- tests labial sounds
- “The Leith police dismisseth us” - multiple processes
- Count to 30- muscles fatigue in MG
How do you test for dysphonia?
Aspects of CNX examination
- Voice: Quiet or bovine
- Cough: “Bovine” (when a patient can’t close their glottis)
- “Say ahhh”: vocal cord tension
How do you test for dysphasia?
- “Name 3 objects”: Nominal dysphasia
- 3 stage command: Receptive dysphasia. Avoid visual clues by instructing from behind
- Repeat sentence: “Today is Thursday”- tests for conductive dysphasia
What are some causes of dysarthria?
- Pseudo-bulbar palsy
- Bulbar palsy
- Cerebellar lesions
What is a pseudo-bulbar palsy?
Impairment of the bulbar nerves due to bilateral UMN lesion in the mid pons
Where is the lesion in a pseudo-bulbar palsy?
Bilateral lesions most commonly in the corticobulbar tract in the brainstem.
What are the signs of a pseudo-bulbar palsy?
- Difficulty with lingual sounds –> “hot potato speech”
- Brisk jaw jerk (as UMN)
- May have difficulty chewing and swallowing
- May show emotional lability
What are the causes of a pseudo-bulbar palsy?
- Vascular: bihemispheric vascular disease e.g. bilateral internal capsule infarcts
- Neurological: MS, MND
- Neoplasia: Brainstem tumour
- Trauma
Why are psuedo-bulbar palsies only seen with bilateral lesions?
Most CN nuclei (except VII and XII) recieve bilateral innervation from the corticobulbar tract i.e. recieve UMN fibres from both hemispheres. This ensures they receive cortical innervation even in the presence of a unilateral pyramidal tract lesion.
What is a bulbar palsy?
Impairment of the bulbar cranial nerves due to a lower motor neuron lesion
What are the signs of a bulbar palsy?
- Unilateral LMN weakness
- Palatal weakness –> nasal “Donald Duck” speech
- May also occur with dysphagia and problems chewing
What are the causes of a bulbar palsy?
- Neurological: MND, GBS
- NMJ disorder: Myasthenia gravis, botulinism
- Vascular: Brainstem vascular disease e.g. basilar ischaemia
- Infection: Poliomyelitis, subacute meningitis, neurosyphilis
- Trauma: Syringobulbia
Where would a lesion causing a bulbar palsy be?
In the medulla, or from lesions of the bulbar nerves outside the brainstem
How would you describe cerebellar speech?
Slurred, drunken speech
What are the causes of dysphonia?
- Medical: Local cord pathology
- Infection: Laryngitis
- Neoplasm: Tumour
- Nodule
- Surgical:
- Recurrent laryngeal nerve palsy
What symptoms would you expect with an expressive aphasia?
- Non-fluent speech
- Intact comprehension
Where is the lesion in expressive dysphasia?
Broca’s area- frontal lobe
What symptoms would you expect in receptive dysphasia?
Fluent but meaningless speech
Impaired comprehension
Where is the lesion in receptive aphasia?
Wernicke’s area- temporal lobe
What symptoms would you expect in a conductive dysphasia?
Intact comprehension
Unable to repeat words or phrases
Where is the lesion in a conductive dysphasia?
Damage to the arcuate fasciculus- connects Broca’s and Wernicke’s area
