PubMed · 13106450
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M MORLEY, D COURT, H MILLER. 1954-01-02. Developmental dysarthria.. https://doi.org/10.1136/bmj.1.4852.8
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The treatment of speech impairment, a factor of loneliness, speech therapy to treat dysarthria in Parkinson's disease is a fundamental aspect of patient management. The impact of medicinal treatment of dysarthria is controversial and surgery appears to worsen the problem. Various speech therapy approaches are relaxation, postural rehabilitation, respiration, phonation, articulation and prosodic re-education. AN INTERESTING METHOD: This overview underlines the fundamental principles of speech therapy in Parkinson's disease and compares the main methods and their results. We particularly insist on the Lee Silverman Voice Treatment (LSVT), phonation re-education method that has been widely developed in the United-States. Our aim is to provide better knowledge on this re-education method in France.
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We report continuous bilateral intracranial pressure (ICP) monitoring immediately after transtentorial herniation in a patient with massive cerebral infarction to: 1) determine presence and time course of compartmental ICP differences, and 2) to study effects of therapy on both hemispheres. A 55-year-old man admitted with watershed infarctions in the left anterior-middle-posterior cerebral arteries distribution. Initial investigations demonstrated highly narrowed left extracranial internal carotid artery. Eight days later he developed unexplained lethargy and anisocoria. Head computerized tomography (CT) showed massive left hemispheric infarction, edema, and midline shift. Bilateral subarachnoid bolts demonstrated equally elevated ICP in both hemispheres. Hyperventilation and osmotic therapy produced near-identical ICP reduction bilaterally with resolution of anisocoria. Later, plateau waves and autonomic instability developed. Shortly before loss of brainstem function, interhemispheric ICP gradients (left greater than right) of 30-40 mm Hg developed. Intracranial pressure did not equalize prior to brain death determination. Bilateral ICP monitoring did not reveal an interhemispheric ICP gradient soon after transtentorial herniation in massive MCA infarction. The presence of interhemispheric ICP gradients in massive stroke remains unproven and further clinical study is necessary.