Speech Problems

Question 1

Dysphasia:

What is it?

What does aphasia mean?

What is the most common cause?

How do you know a patient has confusion instead of dysphasia?

Answer 1

A deficit in the higher language functions

A total absence of speech

LACS

If speech is internally consistent but nonsense

Question 2

Receptive dysphasia:

Another name?

Where is the lesion?

What will the patient not be able to do?

Answer 2

Wernicke’s dysphasia

Temporal lobe lesion

The patient can’t follow a command (e.g. life a hand)

Question 3

Expressive dysphasia:

Another name?

Where is the lesion?

What will the patient not be able to do?

Answer 3

Broca’s lesion

Frontal lobe lesion

Can’t generate speech

Question 4

Nominal aphasia (dysnomia):

Where is the lesion?

What will the patient not be able to do?

Answer 4

Dominent posterior temporo-parietal lesion

Difficulty recalling specific words or names, but the rest of speech is normal

Patients may not be able to name objects shown to them

Question 5

Dysarthria:

What is it?

Causes? - 3

What is done in the cranial nerve exam to test this?

Answer 5

Poor articulation

Bulbar palsy
Pseudobulbar palsy
Facial nerve palsy - rare

Bulbar function:

• Test tongue - la la la
• Palate - ka ka ka

Facial nerve function:
- Lips - ma ma ma

Question 6

Dysphonia:

What is it?

Causes:

• A type of palsy
• 2 neurodegenerative diseases
• A nerve associated with the voice

Answer 6

Reduced speech volume due to weak respiratory muscles or vocal cords.

(Pseudo)bulbar palsy
Myasthenia gravis
Parkinson’s
Recurrent laryngeal nerve invasion

Question 7

Bulbar and pseudobulbar palsy:

What does ‘bulb’ refer to?

What 3 symptoms do you get with these palsies?

Answer 7

Refers to the medulla - dysfunction of cranial nerves 9-12

Dysphonia
Dysarthria
Dysphagia

Question 8

Bulbar palsy:

What is it?

Causes - read

Distinguishing feature:
- Tongue - 2

Answer 8

LMN lesion of the medulla (nuclei) or cranial nerve fibres

Brainstem stroke or tumour 
MND - progressive bulbar palsy 
Guillain-Barre
Myasthenia gravis 
Surgery, radiotherapy 

Fasciculating tongue which sits on one side of the mouth

Question 9

Pseudobulbar palsy:

What is it?

Causes? - read

Do you get bi/unilateral defects?

What happens to the tongue?

Because this also involves all the motor cranial nerves, what signs may you also get?

Answer 9

UMN lesion of the corticobulbar tract - commoner than bulbar palsy

Stroke
MS
MND
Syphilis

Bilateral defects

Paralysed tongue with Donald duck speech

Hyperreflexia (Jaw jerk, gag reflex)
Facial paralysis