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Teaching NeuroImages An 83-year-old woman with phonatory breaks and left hand rest tremor Neurology Resident and Fellow Section © 2013 American Academy.

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Presentation on theme: "Teaching NeuroImages An 83-year-old woman with phonatory breaks and left hand rest tremor Neurology Resident and Fellow Section © 2013 American Academy."— Presentation transcript:

1 Teaching NeuroImages An 83-year-old woman with phonatory breaks and left hand rest tremor Neurology Resident and Fellow Section © 2013 American Academy of Neurology

2 Vignette An 83-year-old woman presented initially with a 20-year history of phonatory breaks Her voice quality deteriorates under stress or with laughter, and shows slight improvement with various relaxation techniques. Speech therapy was not useful Examination revealed a healthy looking female with a two-year history of left hand rest tremor DaTscan SPECT of the brain revealed near symmetrical loss of dopaminergic terminals in the striata Hannah-Shmouni et al

3 Imaging: DaTscan SPECT of the Brain Hannah-Shmouni et al A B

4 Video

5 Spasmodic Dysphonia Preceding Idiopathic Parkinsonism Most Parkinson’s disease (PD) patients will demonstrate vocal difficulties during their disease course 1 Focal dystonia may be the initial presentation of PD and may precede other motor signs by many years Spasmotic dysphonia (SD) is a focal dystonia of the intrinsic laryngeal muscles arising from a dysfunction of the basal ganglia and extrapyramidal tract SD is characterized by intermittent phonatory breaks during voluntary speech Hannah-Shmouni et al

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