Clumsy hand dysarthria syndrome occurs after a lacunar infarction, usually in the bridge or bump of the brain. This type of stroke causes the person to have symptoms that include clumsiness, weakness, and lack of coordination on only one side of the body.

In this article we explain you what is the clumsy hand dysarthria syndrome , what are its causes and symptoms, and what treatment is indicated.

What is clumsy hand dysarthria?

Clumsy hand dysarthria syndrome, or dysarthria syndrome with incoordination of the hand, is one of the rarest and least studied lacunar syndromes . A lacunar syndrome is a clinical picture in which a cerebral infarction of the lacunar type 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 the studies carried out, the most common is the truncuso-encephalic bridge or protuberance, although cases of clumsy hand-dysarthria have also been described in lacunar infarctions in the anterior extremity of the internal capsule, the knee and the radiata crown.

Dysarthria- clumsy hand syndrome makes up 5% of all lacunar syndromes. People who suffer from this syndrome show symptoms such as dysarthria and clumsiness (i.e. weakness) of the hand , which are often more prominent when the patient is writing.

Causes

In the vast majority of lacunar syndromes it has been found that the main cause is a brain lesion caused by a lacunar infarction . However, this has not been able to be demonstrated in the case of dysarthria-hand-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 there have been studies that have concluded that the main cause has been intracerebral hemorrhage in the bridge (or brain bulge) and, sometimes, the cerebellum.

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

It should also be noted that images of the clumsy hand-dysarthria syndrome made by tractography may show small and deep supratentorial infarctions (which are located in the intracranial cavity above the tentorum or tent of the cerebellum), and this would suggest the possibility that this clinical syndrome is secondary to a tandem lesion in the area of the bridge or bulge.

Be that as it may, in the future more studies are required , with greater sensitivity and specificity, which will allow a more precise discrimination of the location of the lesions.

Symptoms

The syndrome of the clumsy hand-dysarthria is characterized by facial paralysis, ipsilateral hemiataxy (coordination defects on one side of the body), especially in the upper limb. The slowness and clumsiness of the hand is mainly evident in the performance of tests that require great precision or dexterity.

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

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

Treatment

Lacunar infarctions often occur in patients with high blood pressure or diabetes mellitus, which is why risk factor analysis and prevention is so important in this type of case.

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

While emergency surgical procedures are sometimes required, this is not usually the case. Once the patient has undergone surgery, he or 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 functions , through exercises such as proprioceptive and sensory stimulation of the affected hemicorpse, postural care or passive mobilization of the affected joints and muscles after the stroke, as well as treating possible complications that occur during the entire process.

2. Neurologist

The task of the neurologist in the rehabilitation of the patient is to follow up on the possible neurological complications that may appear, as well as to request diagnostic and neuroimaging tests, if necessary.

3. Neuropsychologist

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

Once both the 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 full function and autonomy in all areas of his or her life (family, work and social life).

4. Occupational therapist

The occupational therapist ensures that the patient regains the maximum level of autonomy possible after the stroke, if not the same, then at least similar to that before the injury.

The intervention consists of trying to improve and adapt the activities, body structures and functions of the patient to his or her environment, both physical (home, workplace, etc.) and human (family and caregivers). In short, to try to make the person able to function in the day-to-day as best as possible.

Bibliographic references:

  • DĂ­ez-Tejedor, E., Del Brutto, O., Álvarez-SabĂ­n, J., Muñoz, M., & Abiusi, G. (2001). Classification of cerebrovascular diseases. Ibero-American 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.