Ask this patient a few questions.



See Case 48 (pp 147-8)


· The speech may be scanning (enunciation is difficult, words are produced slowly and in a measured fashion) or staccato (in

bursts). Scanning speech is more com-mon in multiple sclerosis, whereas staccato speech is more common in Friedreich's


· Articulation is uneven, words are slurred and variations in pitch and loudness occur.

Proceed as follows:

Tell the examiner that you would like to carry out a neurological examination of the patient for cerebellar signs.

See Cerebellar syndrome (pp 143-5) for discussion.


This patient has scanning speech (lesion) due to cerebellar involvement secondary to chronic alcohol abuse (aetiology).


What do you understand by the term 'dysarthria'?

Dysarthria is impaired articulation of speech. It may result from lesions of muscles, myoneural junctions or motor neurons of lips,

tongue, palate and pharynx. Common causes include mechanical defects such as ill-fitting dentures or cleft palate. Dysarthria may

also result from impaired hearing which begins in early childhood.


How would you test the different structures responsible for articulation ?

· Lips: ask the patient to say, 'me, me, me'. · Tongue: ask the patient to say, 'la, la, la'. · Pharynx: ask the patient to say, 'kuh, gut'.

· Palate, larynx and expiratory muscles: ask the patient to say, 'ah'. In palatal paralysis the patient's speech is worse when the

head is bent forwards.

Articulation can also be tested by asking the patient to repeat the following:

· British constitution.

· Hippopotamus.

· Methodist Episcopal.

· Constantinople is the capital of Turkey.