Clinical study of 35 patients with dysarthria-clumsy hand syndrome.
OBJECTIVE
Although dysarthria-clumsy hand syndrome (DCHS) is a well known and infrequent lacunar syndrome, there are few data regarding the spectrum of associated clinical characteristics, anatomical site of lesion, and aetiopathogenetic mechanisms. We report a clinical description of this subtype of lacunar stroke based on data collected from a prospective acute stroke registry.


METHODS
From 2500 acute stroke patients included in a hospital based prospective stroke registry over a 12-year period, 35 patients were identified as having DCHS.


RESULTS
DCHS accounted for 1.6% of all acute stroke patients (35/2110), 1.9% of acute ischaemic stroke (35/1840), and 6.1% of lacunar syndromes (35/570) admitted consecutively to a neurology department and included in the stroke registry over this period. The results supported the lacunar hypothesis in 94.3% of patients (n = 33). Atherothrombotic and cardioembolic infarction occurred in only one patient each (2.9%). No patient with DCHS had an intracerebral haemorrhage. Outcome was good (mortality in hospital 0%, symptom free at discharge 45.7%). After multivariate analysis, absence of limitation at discharge, limb weakness but not cerebellar-type ataxia, and internal capsule (40%), pons (17%), and corona radiata (8.6%) location were significantly associated with DCHS.


CONCLUSIONS
DCHS is a rare cerebrovascular syndrome, and supports the criteria of the lacunar hypothesis. The majority of patients in this study had internal capsule infarcts. The prognosis is good with striking similarity compared with other types of lacunar strokes. There are important differences between DCHS and non-lacunar strokes. Internal capsule and pons are the most frequent cerebral sites.
Arboix
A
A
Acute Stroke Unit, Department of Neurology, Hospital del Sagrat Cor, Barcelona, Spain. aarboixd@meditex.es
Bell
Y
Y
García-Eroles
L
L
Massons
J
J
Comes
E
E
Balcells
M
M
Targa
C
C
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology*; D020520:Brain Infarction / Q000150:complications*; D002545:Brain Ischemia / Q000150:complications*; D004401:Dysarthria / Q000209:etiology*; D005260:Female; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D020772:Internal Capsule / Q000473:pathology; D008297:Male; D009069:Movement Disorders / Q000209:etiology* / Q000503:physiopathology; D018908:Muscle Weakness / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000503:physiopathology; D011446:Prospective Studies; D012042:Registries