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These areas are in the dominant hemisphere and are described later. The left hemisphere is dominant in right-handed patients and some left-handed patients, and the right hemisphere is dominant in some left-handed patients. 1 Simple model of speech understanding and output The following patterns of aphasia can be recognised and are associated with lesions at the sites as numbered on the figure: 1 Wernicke’s aphasia—poor comprehension; fluent but often meaningless (as it cannot be internally checked) speech; no repetition 2 Broca’s aphasia—preserved comprehension; non-fluent speech; no repetition 3 Conductive aphasia—loss of repetition with preserved comprehension and output 4 Transcortical sensory aphasia—as in (1) but with preserved repetition 5 Transcortical motor aphasia—as in (2) but with preserved repetition Reading and writing are further aspects of language.
With normal rhythm Lower motor neurone: — Palatal: nasal speech, as with a bad cold — Tongue: distorted speech, especially letters t, s and d — Facial: difficulty with b, p, m and w, the sounds avoided by ventriloquists. Myasthenic: — Muscle fatiguability is demonstrated by making the patient count. — Observe for the development of dysphonia or a lower motor neurone pattern of dysarthria. B. ) Before continuing your examination describe your findings. Causes: pseudobulbar palsy (diffuse cerebrovascular disease), motor neurone disease Extrapyramidal dysarthria:Common cause: parkinsonism Cerebellar dysarthria:Common causes: alcohol intoxication, multiple sclerosis, phenytoin toxicity; rarely: hereditary ataxias Lower motor neurone dysarthria:Causes: lesions of X (palatal), XII (tongue) or VII (facial): see relevant chapters.
Focal deficits May indicate early stage of a multifocal disease. Vascular Thrombosis, emboli or haemorrhage. Neoplastic Primary or secondary tumours. Infective Abscess. Demyelinating Multiple sclerosis. Chapter 4 Gait BACKGROUND Always examine the patient’s gait. It is a coordinated action requiring integration of sensory and motor functions. The gait may be the only abnormality on examination, or it may lead you to seek appropriate clinical associations on the rest of the examination. The most commonly seen are: hemiplegic, parkinsonian, marche à petits pas, ataxic and unsteady gaits.