Language disorders beautifully demonstrate the intersection of neuroanatomy and the physical exam. An understanding of both is imperative to being a successful neurologist.

Author: Brian Hanrahan MD, Steven Gangloff MD

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Disorders of articulation

  • Dysarthria: impairment in pronunciation with errors that are consistent and predictable secondary to disturbances in muscle function, whether it be due to weakness, paralysis, or incoordination.
  • Apraxia of speech: Articulatory errors are variable and effect the prosody of speech.

Types of dysarthria

Flaccid (bulbar palsy)

  • Occurs with lower motor neuron disease/neuromuscular junction disease:
    • Commonly seen in patients with bulbar predominant myasthenia gravis.
  • Presents with hypernasal speech and imprecise consonants.

Spastic (pseudobulbar palsy)

  • Secondary to bilateral lesion in corticobulbar (upper motor neuron (UMN)) tracts.
  • Occurs in patients with primary lateral sclerosis (PLS), amyotrophic lateral sclerosis (ALS), progressive supranuclear palsy (PSP), stroke, and other disorders.
  • Presents with a harsh, hypernasal, mono-pitched voice, dysarthria, dysphagia, facial and tongue weakness, and emotional lability.
  • Jaw jerk reflex will be positive and fasciculations are absent (because UMN affected).

Ataxic

  • Presents due to the inaccuracy of muscle movements from cerebellar dysfunction.
    • Seen with acute alcohol intoxication but can be irreversible with chronic use.
  • Speech can be described as imprecise and scanning, with inconsistent errors in articulation.

Hypokinetic

  • Seen in patients with Parkinson’s disease.
  • The speech is described as monotonous and hypophonic.

Hyperkinetic

  • Seen with dystonia and chorea which cause hypotonia and incoordination.


 

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Table of Contents

Table of Contents