Episodic dysarthria related to vascular medullary compression

Abstract

Dear Sirs,Episodic monomorphic complaints such as facial hemispasm, trigeminal neuralgia and typewriter tinnitus are considered pathognomonic for nerve-vessel-contact situations [1]. We present a case of episodic dysarthria as a manifestation of a vascular loop syndrome which has not been reported before. Oral informed consent was obtained from the patient prior to each examination as well as permission to publish the data.At time of admission, a 58 year-old, right-handed gentleman recurrently had brief episodes of slurred articulation during free conversation. Audio-file analysis revealed that dysarthric episodes were triggered during spontaneous speech, singing as well as reading aloud of a standardized text. Events had occurred periodically lasting 20 (±2) s and were followed by asymptomatic intervals of 84 (±10) s. During episodes, the intelligibility of his speech was reduced which affected his work as administrator of an insurance company. He reported a lack of control over articulation, ''as if being drunk'', and showed efforts to overcome his speech deficit. The dysarthric episodes were accompanied by hypomimic facial expression, and incidentally by mild motor disturbance of gait or handwriting. Between episodes articulatory precision and motor skills were all normal.Frenchay Dysarthria Assessment [2] revealed signs of a moderate to severe predominantly spastic dysarthria characterized by reduced intensity, monotonous prosody, strangled and harsh quality of voice, mild hypernasality, slowed articulation with many phonetic distortions and alterations (segment elisions, insertions, and feature changes). Dysarthric episodes occurred in all expressive language modalities: spontaneous speech, repetition, naming and reading aloud. The computerized analysis of the acoustic speech signal revealed that single word production was prolonged by over 30% due to insertion and prolongation of segments resulting in slurred articulation (Fig. 1a, b) [3]. There were marked difficulties to carry out rapid and alternating lip and tongue movements. Swallowing was not considered. Episodes of speech impairment were accompanied by right hand clumsiness and dysdiadochokinesia.At follow-up examination after 6 months, the patient still presented with episodic dysarthria which made him retire early from work. Episodes persisted with an average duration of 20 s, while the asymptomatic intervals eventually had been expanded to an average of 9 min.The neurophysiological examination included an electroencephalogram, sensory, transcranial magnetic, and Electronic supplementary material The online version of this article (