A 76-year-old woman, right-handed, with a history of hypertension, dyslipidemia and hypothyroidism, suffered ischemic cerebrovascular disease (CVD) of the right middle cerebral artery.
In the neurological evaluation performed 12 months after the event, it was observed inexpressive facies, drooling, anarthria, without alterations in the mental sphere, obeyed simple orders, speech promotion decreased taste veil
The osteotendinous reflexes were exalted on the left side with bilateral flexor plantar response.
Blood tests performed on admission (oleucogram, blood glucose, VDRL, TSH, BUN, creatinine, ionogram, coagulation tests) were normal.
Carotid and vertebral duplex ultrasound showed atheromatosis without significant stenosis. The echography showed trivial aortic and tricuspid regurgitation with an ejection fraction of 75%.
Holter showed sinus rhythm with significant bradycardia.
Cranial computed tomography (CT) showed an infarction in the territory irrigated by the right middle cerebral artery.
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Magnetic resonance imaging of the encephalon, performed 18 months after the event, revealed encephalomalacia and gliosis in the territory of the right middle cerebral artery after the m2-m3 junction, with compensatory findings in the left system.
Standardized single diffusion emission tomography (99mTC-HMPAO) showed an important hypoperfusion area that compromised the middle frontal, posterior and parietal regions only in the hemis.
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In the neuropsychological evaluation it was found an anarthric patient, with affective lability, collaborating, with psychomotor slowness, communicating in writing, able to express his concerns and desires, left person rewriting only in time.
At 18 months, psychomotor slowness, mood and spatial agnosia improved.
In the evaluation by speech therapy motor characteristics of his speech through direct observation was found: good understanding of language at conversational level with proper communication through writing.
Anarthria: absence of oral expressive language due to motor disability to voluntarily perform movements with tongue and lips.
Permanent open mouth and constant drooling
Language collected and quite limited in movement
Spastic weakness.
Absence of protrusion.
Oral breathing.
Weakness in the murmur and short duration, affecting the pneumophonic coordination with low respiratory capacity.
Hypophonia and nasal resonance
Organ articulation mobility (speech, palatal velum) severely compromised both for speech and for feeding activities.
Weak suction with a pit, but the drinks offered in a container, simply put them in your mouth.
Basically speaking, soft consistency.
Bite is weak and there is no masticatory movement: soften foods with saliva and short tongue movements.
Dysphagia with frequent risk of bronchoaspiration.
Choking.
Weak cough.
Deautomation of the voluntary phase of reception.
The patient attended several sessions of articulatory therapy and speech therapy involving respiratory muscles, stimulating feeding conditions to reduce the risks of bronchoaspiration and feeling of drowning, pneumo coordination.
It has been possible to improve the control of oral closure, the intensity and duration of the murmur and opening but achieved complete tongue prolongation. There has been decreased saliva closure, while the functionality of the mouthwashing activity decreased spontaneously.
Some clearer melanomas have been achieved (/ a - e - m - 1).
The patient continues to complain in writing.
