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Dysarthria is characterized by dysfunction of the structures implicated in the control, initiation, and coordination of speech output: lips, tongue, jaw, palate, and larynx, which are innervated by the facial, glossopharyngeal, vagal, and hypoglossal nerves. Lesions that cause dysarthria occur in one of several locations along the neuraxis. This chapter presents the clinical features of dysarthria resulting from stroke and its associated neurological signs. Ischemic lesions of the upper motor neuron system may be unilateral or bilateral, cortical or subcortical. Ischemic lesions in the vertebrobasilar territory can result in both upper and lower motor neuron involvement. Ataxic dysarthria is the result of lesions occurring in the territory of the superior cerebellar and posterior inferior cerebellar arteries. Dysarthria can follow ischemic lesions of the extrapyramidal system occurring in the vascular territories of the deep penetrating branches of the anterior and middle cerebral arteries.
The prevalence of poststroke dementia (PSD) varies largely according to the composition of cohorts, setting, and delay after stroke. The cognitive syndrome of vascular dementia (VaD) is characterized by: memory deficit, dysexecutive syndrome, slowed information processing, and mood and personality changes. Cortical VaD relates to large vessel disease, cardiac emboli, and hypoperfusion. It prominently shows cortical and corticosubcortical arterial territorial and distal field infarcts. The occurrence of dementia depends on two factors: the total volume of brain loss because of infarcts and hemorrhages, and the location of these lesions. Many instances of dementia occurring in stroke patients are probably the consequence of the cumulative effect of the cerebrovascular lesions, Alzheimer pathology, and white matter changes. Patients with dementia after stroke are significantly less often treated with aspirin or warfarin than nondemented patients. Trials of secondary prevention of stroke usually exclude patients with obvious dementia.
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