Background and purpose
Subcortical white matter (WM) plays an important role in speech production and language processing. Most frequently, cerebral WM lesions are secondary to small vessel disease in patients with vascular risk factors. We report the case of a 53-year-old man with history of hypertension and ischemic subcortical lesions, who presented with speech difficulties and mild cognitive impairment.
Language and cognitive assessment included Boston Diagnostic Aphasia Examination, Boston Naming Test, Rey Auditory-Verbal Learning Test, Rey-Osterrieth Complex Figure Test, Trail Making Test A and B, Wisconsin Card Sorting Test, Scale for Evaluation of Perceptive Characteristics of Voice and Speech, and Multidimensional Evaluation of Speech and Voice.
Brain MRI showed ischemic WM lesions and lacunar infarcts in the brainstem and right cerebellum. Cognitive testing revealed mild cognitive impairment, predominantly affecting attention and executive functions. Speech and language analysis demonstrated dysarthria, dysphonia with hypophonia, and imprecise articulation, as well as short rushes of speech, palilalia and mild subcortical dysphasia.
Neurolinguistic and acoustic analysis in patients with ischemic WM lesions can provide additional information in the understanding of language and speech disturbances, and can assist in patient management.
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- Contribution to the evaluation of language disturbances in subcortical lesions: a pilot study.Arq Neuro-Psiquiatr. 2004; 62: 51-57
- The contribution of the left and right hemispheres to early recovery from aphasia: a SPECT prospective study.Neuropsychol Rehabil. 2005; 15: 588-604
- Severe nonfluency in aphasia. Role of the medial subcallosal fasciculus and other white matter pathways in recovery of spontaneous speech.Brain. 1989; 112: 1-38
- Subcortical brain mechanisms in speech and language.Folia Phoniatr Logop. 2001; 53: 233-251
- Movement disorders of the larynx.in: Blitzer A. Brin M.F. Sasaki C.T. Fahn S. Harris K.S. Neurologic Disorders of the Larynx. Thieme Medical Pub Inc, New York1992: 248-278
- Speech and language disturbances due to subcortical lesions.Brain Lang. 2003; 84: 337-352
- The assessment of aphasia and related disorders.Lea & Febige, Philadelphia1983
- The Boston naming test.E. Kaplan, H. Goodglass, Boston1978
- Primary mental abilities (Rev).Science Research Associates, Chicago1962
- Mini-Mental State.J Psychiatr Res. 1975; 12: 189-198
- Wechler Adult Intelligence Scale.Society of Pscychologists of Serbia, Belgrade1991
- The Halstead-Reitan Neuropsychological Test Battery: theory and clinical interpretation.Tuscon: Neuropsychology Press, 1985
- A MANUAL for the Wisconsin Card Sorting Test.Psychological Assessment Resources Inc., Odessa Fl.1981
- Le test de copie d′une figure complex: Contribution a l′etude de la perception de la memoire.Arch Psychol. 1944; 30: 286-356
- The Hooper Visual Organisation Test.Eestern Psychological Services, Manual. Los Angeles1958
- L′examen clinique en psychologie.Presses Universitaires de France, Paris1964
- Research for laryngeal cancer evaluation and diagnosis.J Biomech. 1988; 3–2: 45-20
- Measures of vocal function during change in vocal effort level.J Voice. 1995; 9: 429-438
- Comparison of Fo extraction methods for high-precision voice perturbation measurements.J Speech Hear Res. 1993; 36: 1120
- An acoustic analysis of pathological voice and its application to the evaluation of laryngeal pathology.Speech Commun. 1986; : 5-2
- Normalized noise energy as an acoustic measure to evaluate pathologic voice.J Acoust Soc Am. 1986; 80: 1329-1333
- A structured approach to voice range profile (phonetogram) analysisr.J Speech Hear Res. 1994; 37: 1076-1085
- for the European Task Force on Age-Related White Matter Changes. Visual rating scales for age-related white matter changes (leukoaraiosis): can the heterogeneity be reduced?.Stroke. 2002; 33: 2827-2833
- Cerebral small vessel diseases: cerebral microangiopathies.Curr Opin Neurol. 2005; 18: 179-188
- Cerebral small-vessel disease and decline in information processing speed, executive function and memory.Brain. 2005; 128: 2034-2041
- Stroke, cognitive decline and vascular dementia: the silent epidemic of the 21st century.Neuroepidemiology. 2003; 22: 161-164
- Clinicoanatomic studies in dysarthria: review, critique, and directions for research.J Speech Lang Hear Res. 2001; 44: 535-551
- Isolated dysarthria.Stroke. 1991; 22: 531
- Impaired cortico-bulbar tract function in dysarthria due to hemispheric stroke. Functional testing using transcranial magnetic stimulation.Brain. 1997; 120: 1077-1084
- Central inervation of larynx.Acta Otorhinolaryngol Ser. 1998; 3: 571-569
- Subcortical infarction resulting in acquired stuttering.J Neurol Neurosurg Psychiatry. 2000; 69: 546-549
- Lingual discoordination and dysphagia following acute stroke: analyses of lesion localization.Dysphagia. 1999; 14: 85-92
Published online: March 19, 2009
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