Cases reported "Dysarthria"

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1/26. Brainstem anesthesia presenting as dysarthria.

    After having a retrobulbar injection for anesthesia before cataract surgery, a patient developed dysarthria. This was the presenting sign for penetration of the optic nerve sheath by the retrobulbar injection, with subsequent brainstem anesthesia. Thereafter, the patient demonstrated cranial nerve dysfunctions with tongue deviation, tachycardia, hypertension, and contralateral sixth and third nerve palsies. I believe this is the first documented case in which dysarthria is the presenting sign for brainstem anesthesia resulting from a retrobulbar injection.
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2/26. Vagal and hypoglossal Bell's palsy.

    A 7-year-old boy was referred because of a sudden change to nasal speech, dysarthria for words with explosive consonants in speech, and nasal regurgitation of fluids. The symptoms arose over 1 week following a capricious episode of acute asthmatic bronchitis. Physical and neurologic examinations were normal except for a left deviation of the uvula, accompanied by a "curtain" movement of the posterior pharyngeal wall against the opposite side, and a left deviation of the protruded tongue. No vascular, traumatic, infectious, neoplastic, or neurologic causes could be identified. No therapy was administered. Full recovery occurred 4 months later. The diagnosis was idiopathic vagal and right hypoglossal nerve palsy (Bell's palsy).
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3/26. tongue lesions in the pediatric population.

    OBJECTIVE: To describe the spectrum of pediatric tongue lesions treated surgically at Columbia-Presbyterian Medical Center from January 1990 to December 1999. Study design and setting: Retrospective case-series at the pediatric hospital of a tertiary care, academic medical center. RESULTS: Seventeen patients were identified. Their ages ranged from 1 to 132 months (median, 7 months). Eight lesions were located anteriorly: mucous cyst (1), polyp (1), chronic inflammatory mass (1), hamartoma (1), squamous papilloma (2), cavernous hemangioma (1), and vascular malformation (1). Four lesions were located posteriorly: teratoma (1), glial choristoma (1), osseous choristoma (1), and benign epithelial cyst (1). Finally, there were 5 diffuse lesions including macroglossia (4) and massively infiltrating congenital lymphatic malformation (1). Symptoms included respiratory distress (3) and dysarthria (3); all other children were asymptomatic. CONCLUSIONS: This series revealed an interesting spectrum of rare solid tumors; compared with other large series, fewer lymphatic and vascular malformations were seen. Presenting symptoms, differential diagnosis, and surgical approach were differentiated according to lesion location.
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4/26. dysarthria as the isolated clinical symptom of borreliosis--a case report.

    This report presents a case of dysarthria due to hypoglossal nerve mono-neuropathy as the only consequence of neuroborreliosis. The 65-year-old man with a seven-months history of articulation disturbances was examined. The speech of the patient was slow and laboured. A slight weakness of the muscles of the tongue (left-side) was observed. The patient suffered from meningitis due to borrelia burgdorferi infection in 1999 and initially underwent a successful antibiotic treatment. Detailed radiological investigation and psychological tests were performed and co-existing neurological diseases were excluded. To describe profile of speech abnormalities the dysarthria scale was designed based on S. J. Robertson dysarthria Profile. There were a few disturbances found in self-assessment of speech, intelligibility, articulation, and prosody but especially in the morphology of the articulation muscles, diadochokinesis, the reflexes (in the mouth, larynx and pharynx). Needle EMG examination confirmed the diagnosis of mono-neuropathy of left hypoglossal nerve. The study confirms the fact that neuroborreliosis may evoke chronic consequences.
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5/26. Occipital neuralgia and twelfth nerve palsy from a chondromyxoid fibroma.

    The purpose of this case report is to record the unusual combination of occipital neuralgia and hypoglossal nerve palsy causing dysarthria, dysphagia, and unilateral weakness of tongue protrusion, with no other neurological findings. The cause was a discrete tumor in the clivus and the right occipital condyle. Following surgical resection of the tumor, dysarthria and dysphagia persisted. These improved with therapy by a speech therapist, but deviation of the tongue persisted on protrusion. No similar case reports were found in the literature. In addition, the tumor was an unusual one, a chondromyxoid fibroma (CMF); these tumors uncommonly involve the skull base.
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6/26. Lingual epilepsia partialis continua in Rasmussen's encephalitis.

    We report an adult male who presented with disabling dysarthria due to epilepsia partialis continua (EPC) of the left half of the tongue. The clinical, brain magnetic resonance imaging and electroencephalographic features were consistent with Rasmussen's encephalitis, although, despite having had the disease for over 15 years, he did not exhibit any hemiparesis. The accompanying video illustrates the lingual EPC and its total resolution following a right frontal opercular focal cortical resection.
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7/26. tongue dyskinesia as an early manifestation of Wilson disease.

    A 15-year-old boy was diagnosed as having Wilson disease. He perceived involuntary tongue movement and speech disorder since March 1990. The tongue movements presented in the resting state and during action. It contracted transversely and bilaterally with an irregular frequency about 1 Hz. As a result, the sides of the tongue moved to form a narrow central groove. This was quite different from the tongue protrusion of tardive dyskinesia. His speech had imprecise consonants, monopitch, low pitch, low volume, harsh voice, and hyponasality. These suggested that tongue dyskinesia could be an early sign of Wilson disease and was not the main cause of his dysarthria.
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8/26. Opercular syndrome without opercular lesions: Foix-Chavany-Marie syndrome in progressive supranuclear motor system degeneration.

    A patient is described with slowly progressive supranuclear motor system degeneration (primary lateral sclerosis) characterized by pure bulbar spasticity for six years until a spastic tetraparesis developed. Clinically and electrophysiologically there was and still is no evidence of lower motor neuron involvement. Recently the patient presented with a syndrome of complete inability to move face and tongue voluntarily with preservation of the ability to move them "automatically", e.g. within gestures: automatic-voluntary motor dissociation. Loss of voluntary innervation of the facio-pharyngo-glossomasticatory muscles with preservation of involuntary innervation are the features of the Foix-Chavany-Marie syndrome, which to date has most often been described in association with bilateral vascular lesions of the opercula or their cortigofugal projections.
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9/26. Adenoid cystic carcinoma of the tongue presenting as a hypoglossal nerve palsy.

    A case of adenoid cystic carcinoma of the tongue is reported. It was unusual in that its initial presentation was that of a twelfth cranial nerve palsy of unknown origin. A brief review of the literature of this uncommon condition is presented.
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10/26. tremor of tongue and dysarthria as the sole manifestation of Wilson's disease.

    Neurological form of Wilson's disease in children usually manifests with dystonia as the initial sign. tremor of extremities, dysarthria and ataxia may follow. copper deposits in gray and white matter along with the basal ganglia. A pediatric case presenting with tremor of the tongue and dysarthria as the only findings of Wilson's disease is reported. tongue tremor should also be taken into notice within the basal ganglia symptomatology.
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