Pure dysarthria and dysarthria-facial paresis syndrome due to internal capsule and/or corona radiata infarction

Abstract

BackgroundPure dysarthria (PD) and dysarthria-facial paresis syndrome (DFP) mainly result from lenticulostriate artery territory infarction. PD and DFP are rare clinical entities, often grouped without distinction. The purpose of this study was to examine clinical and radiographic differences between PD and DFP due to unilateral internal capsule and/or corona radiata infarction.MethodsUsing a database that included consecutive patients with ischemic stroke admitted to the neurological stroke units of three hospitals within 7 days from onset between September 2011 and April 2014, we retrospectively extracted first-ever stroke patient data, who presented with PD or DFP with a single ischemic lesion localized in the internal capsule and/or corona radiata. Patients with weakness, ataxia, sensory deficit, or cortical symptoms were excluded. Ischemic lesion volume was calculated by the ABC/2 method on diffusion-weighted imaging (DWI). DWI images were normalized and superimposed to the template for PD and DFP. We compared patients' characteristics between PD and DFP.ResultsA total of 2126 patients, including 65 patients (3.1 %) with PD or DFP, were registered. Of these, 13 PD patients and 18 patients with DFP due to unilateral internal capsule and/or corona radiata infarction were included for analysis. Compared with DFP patients, PD patients had longer onset-to-door time (median 37.5 vs. 10.8 h, p = 0.031), shorter vertical length (C component) of ischemic lesions (median 12.0 vs. 18.8 mm, p = 0.007), and smaller ischemic lesion volume (median 285 vs. 828 mm3, p = 0.023). Ischemic lesions causing PD were located more frequently in the left hemisphere than DFP (92 % vs. 56 %, p = 0.045). The superimposed lesion pattern indicated that DFP had lesions more medial and involving posterior portions of the putamen and the caudate body, as well as more of the genu and posterior limb of the internal capsule, than PD. Ninety days after onset, symptoms disappeared in 21 (72 %) out of 29 patients.ConclusionsIn cerebral infarction limited to the internal capsule and/or corona radiata, PD is derived from smaller and left-sided lesions with delay in diagnosis compared with DFP. The clinical course of those with PD and DFP might be benign.

Dysarthria-Facial Paresis and Rostral Pontine Ischemic Stroke

“…In reports of dysarthria and/or facial paresis associated with other localizations, neighborhood signs were often observed, including (in a series of midbrain ischemic infarction or hemorrhage) limb paresis and ipsilateral oculomotor palsy [ 12 ], dysphagia in patients with dysarthria as a presenting feature [ 13 ], and (in a series of lateral medullary infarctions) truncal ataxia and palatal weakness [ 14 ]. In a single case report [ 15 ], supranuclear facial palsy (albeit with accompanying homolateral arm and leg weakness) was observed in a case of basilar dissection and high pontine infarction.…”

Neuroanatomical regions associated with non-progressive dysarthria post-stroke: a systematic review

“…Both ischemic (n = 22) and hemorrhagic (n = 2) strokes were analyzed. The studies presented seven countries, namely Germany [17,[31][32][33][34], Switzerland [19,35,36], Turkey [16,37,38], Korea [39,40], the United States of America [41], Japan [42][43][44][45], and South Korea [18,[46][47][48][49]. The total number of assessed subjects was 1150 adults (aged 18 years and above), out of whom 577 subjects had dysarthria.…”

“…Gender was not addressed in one of the studies, representing 1.57% of subjects (n = 18) [33]. Dysarthria assessment was performed through clinical evaluation (n = 19/24) [16,18,19,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50], conducted either by a neurologist (n = 15/19) [16, 18, 19, 36-42, 44-47, 50], or a psychiatrist (n = 1/19) [49], or unspecified (n = 3/19) [35,43,48]. Dysarthria assessment was also done through a formal assessment tool, performed by experienced speech and language therapists (n = 5/24) [17,[31][32][33][34].…”

“…Corona radiata lesions were documented in six studies [16,31,32,37,45,46], among which two specified lesions of the centrum semiovale area [31,37]. Two articles identified lesions in the corona radiata and/ or internal capsule [43,44]. The Striatocapsular area involved lesions in the basal ganglia and the internal capsule [16,31,34,46].…”

Comprehensive Assessment of Acute Isolated or Prominent Dysarthria in the Emergency Department: A Neuro-Emergency Expert’s Experience beyond Stroke

“…However, it rarely occurs alone or with minor neurological symptoms in patients with acute ischemic stroke [ 4 , 5 , 6 , 7 ]. In the field of stroke, it has been called isolated or prominent dysarthria and is sometimes described as a special neurological syndrome, such as dysarthria-clumsy hand syndrome, dysarthria-facial paresis syndrome, and dysarthria-lingual palsy syndrome [ 8 , 9 , 10 , 11 ]. Pure dysarthria has been described as lacunar syndrome in internal capsule, corona radiata, small cortical, or subcortical lesions [ 10 , 12 ].…”