Dysarthria of clumsy hands: symptoms, causes and treatment

Awkward hand dysarthria syndrome occurs after a lacunar infarction, usually at the bridge or bulge of the brain. This type of stroke causes symptoms such as clumsiness, weakness, and incoordination on one side of the body in the person.

In this article, we explain what it consists of clumsy hand dysarthria syndrome, What are its causes and symptoms, and what treatment is indicated.

    What is dysarthria of clumsy hands?

    Clumsy hand dysarthria syndrome or uncoordinated hand dysarthria syndrome, it is one of the rarest and least studied lacunar syndromes. Lacunar syndrome is a clinical picture in which a lacunar-type brain infarction occurs. These types of heart attacks have small lesions (no more than 15mm in diameter) caused by the occlusion of tiny branches in the perforating arteries of the brain.

    The location of the lesions at the origin of this type of syndrome is not yet clearly defined; however, according to studies the most common is the brainstem or bulge, although cases of awkward hand dysarthria have also been described in lacunar infarcts of the anterior end of the inner capsule, knee and chest. crowned.

    Clumsy hand dysarthria syndrome accounts for 5% of lacunar syndromes and people who suffer from it show it symptoms such as dysarthria and awkwardness (i.e. weakness) of the hand, Which are often more noticeable when the patient is typing.

    the causes

    In the vast majority of lacunar syndromes, it has been found that the main cause is brain damage caused by a lacunar infarction. However, this has not been demonstrated with clumsy hand dysarthria syndrome, possibly because it is one of the rarer syndromes.

    However, studies also point to the lacunar hypothesis as the main cause (over 90% of cases), although cases have also been reported and studies have concluded that the main cause is intracerebral hemorrhage in the bridge (or bulge). brain) and sometimes the cerebellum.

    Therefore, there appear to be different causes and possible localizations responsible for clumsy hand dysarthria syndrome, possibly due to the fact that in this syndrome there is partial involvement of motor fibers along the pyramidal tract, Secondary to a small lacunar infarction which interrupts the corticospinal fibers, regardless of the location of the lesion.

    It should also be noted that in images of dysarthria-clumsy hand syndrome taken with tractography, small and deep supratentorial infarctions (located in the intracranial cavity above the tentorium or cerebellum) may be observed, suggesting the possibility that this clinic Syndrome is secondary to a tandem injury in the area of ​​the bridge or bulge.

    In both cases, further studies are needed in the future, With greater sensitivity and specificity, which allow more precise discrimination of the location of lesions.

      symptoms

      Clumsy Hand Dysarthria Syndrome stroke with facial palsy, ipsilateral hemiataxis (Coordination faults on the same side of the body), especially in the upper limb. Slowness and clumsiness of the hand is manifested mainly in the performance of tests which require great precision or dexterity.

      They are detailed below other of the most characteristic symptoms of this lacunar syndrome:

      • Illness and lack of manual dexterity.
      • Facial weakness.
      • Dysphagia (difficulty swallowing).
      • Dysarthria (difficulty in articulating movements due to paralysis or lack of coordination).
      • Paresis of the arm (partial paralysis or weakness).
      • Hyperreflexia or ipsilateral Babinski’s sign.

      treatment

      Lacunar infarctions usually occur in patients with high blood pressure or diabetes mellitus, which is why the analysis of risk factors and prevention in such cases is so important.

      Although clumsy hand dysarthria syndrome is the classic lacunar syndrome with the best short-term functional prognosis, it should be remembered that this type of clinical picture should be treated as soon as possible, Because after a heart attack, there is a window of about 3 or 4 hours in which it is essential to intervene and start treatment.

      While emergency surgeries are sometimes necessary, this is usually not the case. The patient, once operated, must begin a complete rehabilitation process which includes a visit to various health professionals.

      1. Physiotherapist

      The role of the physiotherapist in the rehabilitation process is help the patient to regain his motor functions, Through exercises such as proprioceptive and sensory stimulation of the affected hemibody, postural care or passive mobilizations of the affected joints and muscles after stroke, as well as the treatment of possible complications that arise throughout the process.

      2. Neurologist

      The task of the neurologist in the rehabilitation of the patient is to monitor any neurological complications that may appear, as well as to request the performance of diagnostic tests and neuroimaging, if necessary.

      3. Neuropsychologist

      The role of the neuropsychologist is crucial in the rehabilitation process after suffering from lacunar syndrome, such as dysarthria syndrome of the clumsy hand. Your job is detect alterations in higher cognitive functions (Attention, memory, executive functions, etc., which result from a head trauma.

      Once the altered and preserved abilities have been detected, the neuropsychologist will work with the patient to restore or compensate for these skills, with the ultimate goal of making the patient independent and fully functional in all areas of their life. professional and social level).

        4. Occupational therapist

        The occupational therapist is in charge of that the patient regains maximum autonomy possible after stroke, if not the same, yes at least similar to what I had before the injury.

        The intervention consists of trying to improve and adapt the activities, body structures and functions of the patient to his environment, both physical (home, workplace, etc.) and human (his family and caregivers ). day to day as best as possible.

        Bibliographical references:

        • Díez-Tejedor, E., De l’Brutto, O., Álvarez-Sabín, J., Muñoz, M., and Abiusi, G. (2001). Classification of cerebrovascular diseases. Ibero-American Society of Cerebrovascular Diseases. Rev Neurol, 33 (5), 455-64.
        • Tuhrim, S., Yang, WC, Rubinowitz, H. and Weinberger, J. (1982). Primary pontine hemorrhage and awkward hand dysarthria syndrome. Neurology, 32 (9), 1027-1027.

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