«Dysarthria–clumsy hand syndrome» as lacunar stroke manifestation

Abstract

A detailed analysis of the neurological disorders of «dysarthria–clumsy hand» syndrome (DCHS) is important for its earlier diagnosis. The purpose of this study was to evaluate the incidence of DCHS and the range of its clinical signs, as well as the degree of hand/arm dysfunctions and its dynamics in patients with the acute lacunar stroke (LS). Material and methods. 139 patients with acute LS were examined. Quantitative assessment of neurological deficits, such as paresis, cerebellar ataxia, and apraxia was performed using the relevant scales. The upper limb function was assessed by Action Research Arm Test and 9-Hole Peg Test. Barthel Index was used for disability evaluation. Results. DCHS was diagnosed in 17% of LS patients (group1) and other clinical variants of LS was detected in 83% of patients (group 2). The cause of «clumsiness» in the hand/arm in DCHS was ataxia (83%), mild paresis (71%) and kinesthetic apraxia (29%), which were present independently or in combination. Hand/arm dysfunction and disability, while performing daily activities, were less severe in group 1 patients compared to group 2. The complete restoration of hand/arm function was observed in 63% of the patients with DCHS in 2 weeks after the onset of LS. Conclusions. Mild paresis, cerebellar ataxia and apraxia are the main causes of «clumsiness» of the hand/arm in patients with DCHS. In general, DCHS has good functional outcomes.