Dysarthria-clumsy hand: symptoms, causes and treatment.

A lacunar syndrome that affects the ability to move the hand and other muscle groups.

Dysarthria-clumsy hand syndrome occurs after a lacunar infarction, usually in the bridge or pons of the brain. This type of stroke causes symptoms in the person that include clumsiness, weakness and incoordination on only one side of the body.

In this article we explain what is dysarthria-clumsy hand syndromewhat are its causes and the symptoms that it provokes, and what treatment is the indicated one.

What is dysarthria-clumsy hand?

The dysarthria-clumsy hand syndrome, or dysarthria syndrome with incoordination of hand, is one of the rarest and most understudied of the lacunar syndromes.. A lacunar syndrome is a clinical picture in which a lacunar-type cerebral infarction occurs. This type of infarction presents small lesions (no more than 15 mm in diameter) caused by the occlusion of tiny branches in the perforating arteries of the brain.

The location of the lesions that cause this type of syndrome has not yet been clearly defined; however, according to studies, the most common is the brainstem bridge or pons, although cases of dysarthria-clumsy hand have also been described in lacunar infarcts in the anterior extremity of the internal capsule, the knee and the corona radiata.

Dysarthria-clumsy hand syndrome constitutes 5% of lacunar syndromes, and sufferers manifest symptoms such as dysarthria and clumsiness of the hand. symptoms such as dysarthria and clumsiness (i.e. weakness) of the hand, which are often more prominent.which are often most prominent when the patient is writing.

Causes

In the vast majority of lacunar syndromes, it has been shown that the main cause is a brain injury caused by a lacunar infarction. a cerebral lesion provoked by a lacunar infarction.. However, this has not been demonstrated in the case of dysarthria-clumsy hand syndrome, probably because it is one of the most infrequent syndromes.

However, studies also point to the lacunar hypothesis as the main cause (more than 90% of cases), although cases have also been reported and studies have concluded that the main cause has been an intracerebral hemorrhage in the pons (or pons of the brain) and, sometimes, the cerebellum.

Therefore, there appear to be different possible causes and locations responsible for the dysarthria-clumsy hand syndrome, possibly because in this syndrome there is a partial involvement of the motor fibers along the pyramidal tractsecondary to a small lacunar infarct that disrupts the corticospinal fibers, regardless of where the lesion is located.

It should also be noted that small, deep supratentorial infarcts (which are located in the intracranial cavity above the tentorium or tentorium of the cerebellum) can be seen on tractographic images of dysarthria-clumsy hand syndrome, and this would suggest the possibility that this clinical syndrome is secondary to a tandem lesion in the area of the pons or pons.

Be that as it may, further studies are required in the futurewith greater sensitivity and specificity, allowing more precise discrimination of the location of the lesions, are required in the future.

Symptoms

The syndrome of dysarthria-clumsy hand presents with facial palsy, ipsilateral hemiataxia (coordination defects on the same side of the body), especially in the upper extremity. Slowness and clumsiness in the hand is mainly evident in the performance of tests requiring great precision or dexterity.

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

• Clumsiness and lack of manual dexterity.
• Facial weakness.
• Dysphagia (difficulty to swallow).
• Dysarthria (difficulty to articulate movements due to paralysis or lack of coordination).
• Paresis of the arm (partial paralysis or weakening).
• Hyperreflexia or homolateral Babinski's sign.

Treatment

Lacunar infarcts usually occur in patients with arterial hypertension or Diabetes mellitus, which is why it is so important to analyze risk factors and prevention in this type of case.

Although dysarthria-clumsy hand syndrome is the classic lacunar syndrome with the best short-term functional prognosis, we must not forget that this type of clinical picture should be treated as soon as possible, since after the infarctionAfter the infarction, there is a window of 3 or 4 hours in which it is essential to intervene and initiate treatment.

Although emergency surgical procedures are sometimes required, this is not usually the case. Once the patient has undergone surgery, he/she must begin a comprehensive rehabilitation process that includes visits to various health professionals.

1. Physiotherapist

The role of the physiotherapist in the rehabilitation process is to help the patient to recover motor functionsThe neurologist will provide the patient with a range of treatments, such as proprioceptive and sensory stimulation of the affected hemibody, postural care or passive mobilization of the affected joints and muscles after the stroke, as well as treating possible complications that may occur during the whole process.

2. Neurologist

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

Neuropsychologist

The role of the neuropsychologist is fundamental in the rehabilitation process after suffering a lacunar syndrome, such as dysarthria-clumsy hand syndrome. His/her task is to to detect the alterations of the superior cognitive functions (attention, memory, executive functions, etc.) derived from the brain injury.

Once both altered and preserved abilities have been detected, the neuropsychologist will work with the patient to restore or compensate for these abilities, with the ultimate goal of returning the patient to being autonomous and fully functional in all areas of his or her life (family, work and social).

4. Occupational therapist

The occupational therapist is in charge of that the patient recovers the maximum level of autonomy possible after the stroke, if possible after the cerebral infarction, if not the same, at least similar to what he/she had before the injury.

The intervention consists of trying to improve and adapt the patient's activities, body structures and functions to his or her environment, both physical (home, workplace, etc.) and human (family and caregivers). In short, to ensure that the person can function as well as possible on a day-to-day basis.

Bibliographical references:

• Diez-Tejedor, E., Del Brutto, O., Alvarez-Sabin, J., Munoz, M., & Abiusi, G. (2001). Classification of cerebrovascular diseases. Iberoamerican Society of Cerebrovascular Diseases. Rev Neurol, 33(5), 455-64.
• Tuhrim, S., Yang, W. C., Rubinowitz, H., & Weinberger, J. (1982). Primary pontine hemorrhage and the dysarthria-clumsy hand syndrome. Neurology, 32(9), 1027-1027.