Bulbarny dizartriya — loss of articulateness of the expressional speech owing to frustration of an innervation of articulation bodies at defeat IX, X, XII pairs of cranial nerves. It is clinically shown by a smazannost, slowness, monotony, scarcity of speech production against the background of a dysphonia and the accompanying disorders of swallowing. The Bulbarny dizartriya is diagnosed according to neurologic and logopedic inspection, for identification of the reason of pathology the research of a cerebral blood-groove, the analysis of a likvor is conducted by brain KT or MPT. Treatment is performed according to a disease etiology, supplemented with logopedic correction, the general rehabilitation, neurotyre-tread therapy.
The concept "dizartriya" unites various violations of the proiznositelny party of the speech which are followed by loss of distinctness of speech production. Dizartriya caused by defeat of bulbarny group of craniocereberal nerves received in neurology the name bulbarny. The Bulbarny dizartriya is not a separate disease, is observed along with other manifestations of damage of bulbarny nerves, symptoms of causal pathology. Diseases are subject persons of any age: from newborns to very old men. At adults the bulbarny dizartriya most often arises after the had stroke, heavy ChMT, at children's age — owing to neuroinfections, injuries, cerebral tumors.
Reasons of a bulbarny dizartriya
Speech frustration are formed as a result one - or bilateral damage of the bulbarny nerves providing an innervation of the articulation device. The Yazykoglotochny nerve (IX) innervates pharyngeal muscles, wandering (X) — a soft palate, a throat, the top departments of airways, hypoglossal (XII) — language muscles. Damage of cerebral structures in the field of kernels and backs of nerves of bulbarny group is caused by the following etiofaktor:
- Craniocereberal trauma. The bruise, a sdavleniye, a razmozzheniye, formation of an intracerebral hematoma becomes the reason of damage of brain fabrics. Similar traumatizing is possible during natural childbirth in the conditions of clinically narrow basin, the wrong provision of a fruit, anomaly of patrimonial activity.
- Tserebrovaskulyarny insufficiency. Violations of blood supply of area of localization of bulbarny kernels, an exit of backs of the corresponding nerves lead to ischemia and dysfunction of nuclear neurons and nervous fibers. Sharp ischemia arises at an ischemic or hemorrhagic stroke. Chronic ischemia develops gradually owing to cerebral atherosclerosis, a hypertension, a diabetic angiopatiya.
- Neuroinfections. Defeat of bulbarny backs and kernels is result of inflammatory changes, a compression edematous brain fabrics. The Bulbarny dizartriya is possible at viral encephalitis, an encephalomeningitis, neurosyphilis, cerebral echinococcosis, bulbarny option of poliomyelitis, brain abscess.
- Brain tumors. Medulloblastoma, gliomas, cerebral metastasises of tumors of other localizations provoke bulbarny dysfunction owing to destruction of cerebral cages in the course of invasive growth. Good-quality new growths (astrotsitoma, ependimoma) in process of growth cause a compression of bulbarny structures.
- Neurodegenerate diseases. Are in most cases genetically determined. The side amyotrophic sclerosis, olivopontotserebellyarny degenerations, a metachromatic leykodistrofiya, bulbospinalny amyotrophy of Kennedy proceed with formation of degenerate and atrophic focuses in medulla tissues. Symptoms of a dizartriya develop as a result of a neyronalny degeneration of bulbarny kernels.
- Kraniovertebralny anomalies. Seldom act as an etiofaktor of bulbarny dysfunction. The Bulbarny dizartriya is observed in the cases of a malformation of Kiari, assimilation of the Atlas, a bazilyarny impressiya which are followed by a medulla sdavleniye.
Defeat at the level of trunks, backs and/or kernels of bulbarny group of nerves located in a medulla leads to peripheral paresis of the muscles innervated by them. The tone and force decreases, atrophies of muscles of a throat, a throat, language develop that causes weakening of movements, necessary for an articulation. Loss of sonority of a voice, clearness of the said sounds is result. Paresis of the wandering nerve becomes the reason of a svisaniye of a soft palate, at a fonation a part of the exhaled air leaves through a nose that leads to emergence of twang — a nasal shade of the speech. As besides articulation function of a muscle of a throat provide kinetics of a pharyngeal reflex, the dizartriya is followed by disorder of swallowing (dysphagy).
Symptoms of a bulbarny dizartriya
The muffled simplified articulation is typical. Smychny sounds and a vibrant "" are replaced with slot-hole. Ringing sounds are absent, deafs prevail. Fonation of stressed and unstressed vowels is averaged, the sound is most kept "and". The rhythmical pattern of the word is roughly distorted. Speech production loses expressiveness, melody, becomes monotonous, disritmichny, greased, slowed down. The expressional speech is difficult and tires the patient.
The Bulbarny dizartriya is combined with a dysphonia — decrease in loudness and sonority of a voice. Hoarseness and a nasalization (twang) of a voice is characteristic. As the accompanying symptom the dysphagy — the complicated swallowing which is followed by a popyorkhivaniye acts. In the beginning there are problems with reception of liquids which owing to paresis of a soft palate quite often get into the patient's nose. Then disorders of swallowing extend to reception of firm food. Often along with bulbarny dysfunction the damage of a facial (VII) nerve which is shown weakness of mimic muscles is observed. At unilateral defeat asymmetry of the person is noted.
At a bulbarny dizartriya the variable general and focal neurologic symptomatology corresponding to the main disease can come to light. Headaches, dizzinesses, nausea, a hemiparesis, an ataxy, a meningealny syndrome are possible. Infectious and inflammatory diseases proceed with temperature increase of a body. In some cases ChMT is observed a "light" interval after which there is an increase of symptomatology, oppression of consciousness of the patient.
The expressed dizartriya breaks communicative abilities of the patient, limits his communication with people around, leads to social disadaptation. Awareness of speech defect, existence of the accompanying neurologic deficiency negatively affects the mental sphere, can provoke depressive neurosis, morbid depression. Periodic hit of food in airways owing to a dysphagy is fraught with development of aspiration pneumonia. Bilateral frustration of an innervation of guttural muscles is dangerous by developing of neyropatichesky paresis of a throat with respiratory violations up to asphyxia. The most terrible complication is the bulbarny paralysis caused by the progressing damage of a medulla with involvement of the respiratory and cardiovascular center. The progressing heart and respiratory failure can become a cause of death of the patient.
Verification of the diagnosis is carried out by the neurologist. Identification of a dizartriya is insufficient, establishment of its etiology, assessment of extensiveness of defeat of cerebral fabrics, the prospects of development of a disease is necessary. Help to establish the exact diagnosis:
- Neurologic research. In the neurologic status the bulbarny triad is defined: dizartriya, dysphonia, dysphagy. Palatal and pharyngeal reflexes are sharply lowered. Atrophic changes, a skladchatost, language fastsikulyation are typical. Unilateral defeat is characterized by a svisaniye of a half of a palatal curtain, a deviation of the language which is put out from a mouth kontrlateralno to the center, bilateral — a glossoplegiya (a language immovability).
- Consultation of the logopedist. Includes diagnostics of oral speech (a fonation, speed, a rhythm, a prosodika), assessment of volume of articulation kinetics, synchronism of breath, a condition of mimic muscles. The research of phonemic hearing, slukhorechevy memory, a written language (reading, the letter) of pathology does not reveal.
- Neurovisualization. Allows to define a morphological substratum of a dizartriya, to diagnose causal pathology. For visualization of hematomas, cerebral cysts use brain KT. In diagnosis of a stroke, intracerebral tumors, degenerate processes MRT is more informative. Application of PET-KT revealing dismetabolichesky sites of brain fabric is in addition possible.
- Assessment of cerebral blood circulation. It is necessary in case of chronic distsirkulyatorny encephalopathy, carotid occlusion. It is carried out by means of UZDG, duplex scanning, MRT of vessels.
- Lyumbalny puncture. It is made for a fence and the subsequent analysis of tserebrospinalny liquid. The indication to a puncture is the assumption of the infectious and inflammatory nature of pathology.
- Histologic research of samples of brain fabric or the tumor got by an intraoperative or stereotaksichesky biopsy. It is carried out for the purpose of verification of a tumor, diagnosing of difficult cases of degenerate pathology.
Clinically bulbarny dizartriya is differentiated from the psevdobulbarny syndrome which is a consequence of defeat of kortiko-bulbarny paths. Speech violations at a psevdobulbarny syndrome are followed by the central paresis of the articulation device with a typical hyper reflection and a muscular hyper tone, lack of atrophies. Existence of symptoms of oral automatism is characteristic. Safety of a written language, slukhorechevy memory, phonemic hearing distinguish a dizartriya from other speech violations: motor, dynamic, akustiko-mnestichesky aphasia.
Treatment of a bulbarny dizartriya
Correction of speech frustration is carried out within rehabilitation of patients after the had stroke, ChMT, encephalitis. Logopedic work is successful only at efficiency of treatment of causal pathology, is more productive when holding the accompanying rehabilitation actions. The main directions of therapy are:
- Etiopatogenetichesky treatment. At the infectious nature of a disease it is carried out by antibacterial, antiviral, antimikotichesky pharmaceuticals. At tumors together with the neurosurgeon the issue of radical removal is resolved. At ONMK the differentiated therapy according to stroke type is carried out.
- Neurometabolic correction. It is directed to compensation and the fastest recovery of cerebral neurons, nervous fibers. Includes improvement of cerebral haemo dynamics, nootropic, neurotyre-tread means.
- Correction of a dizartriya. Logopedic occupations assume statement and automation of an articulation, articulation exercises, logopedic massage, respiratory gymnastics. In process of restoration work on smoothness, expressiveness of the speech is carried out.
- Rehabilitation therapy. It is directed to restoration of motility, the psychoemotional sphere of the patient, the maximum social adaptation. It is made by the doctor of LFK, the massage therapist, reabilitology, the psychologist, if necessary – the psychotherapist.
Forecast and prevention
The outcome in many respects is defined by a disease etiology. Correct therapy with timely logopedic support provides the favorable forecast at a possibility of knocking over of causal pathology. A number of patients has residual speech violations. Heavy bulbarny dysfunction can lead to lethal disorders of breath and warm activity. The forecast at malignant new growths of a brain, quickly progressing degenerate diseases is most adverse. Primary prevention is directed to the prevention of cerebral defeats of traumatic, ischemic, infectious, oncological character. Correction of arterial pressure, lipidic exchange, timely treatment of tserebrovaskulyarny pathology has paramount value.