Slide 1

Teaching NeuroImages

An 83-year-old woman with phonatory breaks and left hand rest tremor

NeurologyResident and Fellow Section

2013 American Academy of Neurology

VignetteAn 83-year-old woman presented initially with a 20-year history of phonatory breaksHer voice quality deteriorates under stress or with laughter, and shows slight improvement with various relaxation techniques. Speech therapy was not usefulExamination revealed a healthy looking female with a two-year history of left hand rest tremorDaTscan SPECT of the brain revealed near symmetrical loss of dopaminergic terminals in the striataHannah-Shmouni et al

LINK TO ONLINE ARTICLE:PASTE LINK TO ONLINE ARTICLE HERE.2Imaging: DaTscan SPECT of the BrainHannah-Shmouni et al

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FIGURE LEGEND:Figure. A- This image reveals the patients near symmetrical loss of dopaminergic terminals in the striata. B- A typical age-matched normal scan (note especially the relatively preserved signal in the putamina, i.e. the tails of the commas of intense signal).3Video

Video Legend:Notice the phonatory breaks in voice quality consistent with spasmodic dysphonia.4Spasmodic Dysphonia Preceding Idiopathic Parkinsonism

Most Parkinsons disease (PD) patients will demonstrate vocal difficulties during their disease course1 Focal dystonia may be the initial presentation of PD and may precede other motor signs by many yearsSpasmotic dysphonia (SD) is a focal dystonia of the intrinsic laryngeal muscles arising from a dysfunction of the basal ganglia and extrapyramidal tractSD is characterized by intermittent phonatory breaks during voluntary speechHannah-Shmouni et al

REFERENCES:1. Ho AK, Iansek R, Marigliani C, et al. Speech impairment in a large sample of people with Parkinsons disease. Behav Neurol 1998;11: 131137. 5