Pure dysarthria due to pontine infarction]

A 60-year-old man developed dysarthria in the morning. Neurological examination revealed no abnormality except for dysarthria. We diagnosed the patient as having a lacunar infarction. T2-weighted brain MRI revealed hyperintense lesion in the ventrolateral portion of the left upper pontine base. The clinical symptom completely disappeared on day 20. This is the first report on the MRI findings of the patient who showed pure dysarthria, which responsible lesion is in the pontine base. Involvement of corticopontine and corticobulbar tracts were considered to be responsible for the dysarthria in this case. This case may be useful for the somatotopy of corticopontine and corticobulbar tracts with articulation in the pontine base.     

Pure dysarthria due to small cortical stroke

The authors describe six patients who presented with dysarthria as their isolated or major symptom from a small cortical stroke. Five had infarction and one had hemorrhage. In the patients with ischemic stroke, the lesions were identified by diffusion-weighted MRI but not by T-2 weighted MRI. The lesions were located lateral to the precentral knob usually at the most lateral part of the imaging. The presumed pathogenesis included embolism in five patients and hypertensive hemorrhage in one.     

Lesions to the posterior insular cortex cause dysarthria

Background: Up to now, there are few systematic studies in a sufficient number of patients with lesions involving the insular cortex (IC) examining whether damage of the IC is directly related to dysarthria. Thus, this is the first study applying modern voxel‐lesion behaviour mapping (VLBM) aimed to examine whether the IC is involved in dysarthria – and if so – which part of the IC is involved. Methods: Twenty‐five patients with acute stroke lesions affecting the IC and peri‐insular region were investigated employing VLBM analysis. Results: Present data indicated that dysarthria is associated with stroke lesions affecting the right‐ and left‐sided posterior IC. Conclusions: Owing to the known extensive spectrum of cortical and subcortical somatosensory and motor connections, it seems that the IC might be one region involved in the generation of speech motor execution.     

Pure dysarthria due to anterior internal capsule and/or corona radiata infarction: a report of five cases.

Five cases with a sudden onset of dysarthria in the setting of hypertension are presented. No case had limb weakness or other neurological deficits. Computed tomographic scan demonstrated a small low density lesion in the anterior part of the internal capsule or the adjacent corona radiata. All cases showed a good recovery from dysarthria within two to four weeks.     

Pure motor hemiplegia due to pyramidal infarction.

A 77-year-old man suddenly developed left hemiplegia without sensory impairment, visual or speech difficulties, loss of consciousness, or ataxia. He died one month later of pulmonary embolism, and a cystic infarction in the right medullary pyramid was the only lesion in the corticospinal system.     

Pure homonymous hemianopia due to anterior choroidal artery territory infarction

The most consistently observed neurological deficits in the anterior choroidal artery (AChA) territory infarction are pure motor or sensorimotor syndromes. Visual field defects and higher cortical dysfunction are occasionally accompanied, but pure homonymous hemianopia without motor and sensory symptom has never been reported yet. We present 2 patients with pure homonymous hemianopia, whose MRI disclosed cerebral infarction in the well-known territory of the AChA. In most patients with ischemic stroke, pure homonymous hemianopia indicates infarction in the posterior circulation, particularly in the posterior cerebral artery territory. However, the present cases provide evidence that it can also be caused by infarction in the anterior circulation, i.e. the AChA.     

Pure motor hemiparesis due to pontine infarction as the presenting sign of neurosyphilis

A 50-year-old man with minimal risk factors for cerebrovascular disease had a pure motor hemiparesis due to a pontine infarction. Syphilis serology and CSF findings indicated a previously unrecognized meningovascular syphilis as the cause of the stroke. At variance with the majority of recently reported cases, no prodromal syndrome preceded the cerebrovascular event, and there was no HIV coinfection. Treatment with erythromycin and minocycline was followed by clinical improvement and normalization of main CSF parameters including VDRL; oligoclonal bands and local IgG synthesis, however, were still detectable in post-treatment CSF.     

Paroxysmal dysarthria and ataxia after midbrain infarction

The authors describe a patient who showed paroxysmal dysarthria and right-limb ataxia after midbrain infarction. SPECT imaging showed marked hypoperfusion in the left parietal lobe while the patient was having frequent paroxysmal attacks. After treatment with phenytoin, the symptoms and hypoperfusion in SPECT imaging improved. The authors conclude that dysfunction of the cerebellothalamocortical pathway after midbrain infarction may cause paroxysmal dysarthria and ataxia.     

Neglect after right insular cortex infarction

BACKGROUND AND PURPOSE: Case reports have shown an association between right insular damage and neglect. The aim of this study was to examine the incidence of neglect among patient groups with right or left insular infarction. METHODS: We examined neglect in 9 right-handed subjects with insular stroke as evidenced by CT and/or MRI scans (4 with right insular and 5 with left insular cerebrovascular accident) between 4 and 8 weeks after acute stroke with tests of visual, tactile, and auditory perception. RESULTS: Compared with patients with left insular lesions, patients with right insular lesions showed significant neglect in the tactile, auditory, and visual modalities. CONCLUSIONS: The right insular cortex seems to have a role in awareness of external stimuli, and infarction in this area may lead to neglect in multisensory modalities.     

Pure sensory stroke due to pontine haemorrhage

Summary Two cases of pure sensory stroke due to pontine haemorrhage are reported. Haematomas were located in the dorsolateral tegmentum of the pons, detected by computed tomographic scan. One showed the cheiro-oral syndrome on the left side. The other showed sensory dysaesthesia on the right side of the body, followed by dysaesthesia of cheiro-oral distribution. These cases indicate that the pons can also be one of the lesion sites of pure sensory stroke.     

A case of cerebellar infarction with pure dysarthria]

We report a 69-year-old man with pure ataxic speech. He was admitted to the surgical ward of our hospital because of exercise-induced pain in the right arm. He underwent angiography of the right arm, and was discharged the next day. When he returned home, he exhibited an acute-onset dysarthria. He was admitted to our neurology ward the next day because the dysarthria did not improve. On admission, neurological examinations revealed moderately ataxic speech, but other neurological findings were within normal limits. Cranial MRI revealed an infarct localized from the lobulus simplex to the lobulus quadrangularis in the right cerebellum. Three cases of pure dysarthria due to cerebellar infarction have been reported previously. We compared cerebellar lesions in the 4 cases of pure dysarthria due to cerebellar infarction. Since the lobulus simplex of the upper cerebellar hemisphere was involved in all 4 cases, we speculated that ataxic speech occurred from the impairment of this cerebellar area.