Abstract
We reported five cases with sudden onset of severe supranuclear dysarthria and dysphagia following recurrent minor stroke.
The subjects included one patient with bilateral putaminal hemorrhage, two patients with bilateral infarction in the region of the penetrating branches of the middle cerebral artery, one patient with putaminal hemorrhage followed by contralateral infarction, and one patient with putaminal hemorrhage after contralateral silent infarction. Four patients had almost improved before the recurrence damaging the contralateral hemisphere.
The outstanding clinical features were severe dysarthria and dysphagia compared to minimal limb involvement. No gait disturbance, emotional incontinence, intellectual impairment, extrapyramidal signs, or sphincter disturbances were observed. CT scan showed bilateral lesions involving the genu of the internal capsule and/or the junction of the internal capsule with the corona radiata.
These findings suggest that the corticobulbar tract is located in the genu of the internal capsule and the junction of the internal capsule with the corona radiata, and that bilateral damage to the corticobulbar tract at these levels could play an important role in the development of severe dysarthria and dysphagia.
