Dysarthria: Difference between revisions

Latest revision as of 02:11, 3 October 2019

Background

Motor speech disorder characterized by poor articulation of language sounds or pronounciation^[1]
Cranial nerves involved include trigeminal nerve's motor branch (V), facial nerve (VII), glossopharyngeal nerve (IX), vagus nerve (X), and hypoglossal nerve (XII).

Clinical Features

Includes abnormality to any of the following: breath control, duration of syllables, pitch, range, speed, steadiness, timing, tone, vocal quality, pitch, volume^[2]

Differential Diagnosis

Stroke Types

Weakness

Neuromuscular weakness

UMN:
- - CVA (Main)
  - Hemorrhagic stroke
  - Multiple sclerosis
  - Amyotrophic Lateral Sclerosis (ALS) (UMN & LMN)
- Spinal cord disease:
  - Infection (Epidural Abscess (Spinal))
  - Infarction/ischemia
  - Trauma (Spinal Cord Syndromes)
  - Inflammation (Transverse Myelitis)
  - Tumor
- Peripheral nerve disease:
  - Lyme disease
  - Guillain-Barre syndrome
  - Toxins (Ciguatera)
  - Tick paralysis
  - Diabetes mellitus neuropathy (non-emergent)
- NMJ disease:
- Muscle disease:
  - Rhabdomyolysis
  - Dermatomyositis
  - Polymyositis
  - Alcoholic myopathy
Non-neuromuscular weakness
- Can't miss diagnoses:
  - Sepsis (Main)
  - Hypoglycemia
  - Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
    - Hypokalemic periodic paralysis
    - Thyrotoxic periodic paralysis
  - Respiratory failure
- Other

Evaluation

Clinical diagnosis
Consider CVA or other neurologic workup

Management

Treat underlying cause
Speech pathology

Disposition

Depends on underlying cause

References

↑ Duffy, J. Defining, Understanding, and Categorizing Motor Speech Disorders. In: Duffy, J. Motor Speech Disorders: Substrates, Differential Diagnosis, and Management. 3rd ed. . St. Louis, Mo: Elsevier Mosby; 2012 ISBN 0323024521.
↑ MacKenzie, C (2011). "Dysarthria in stroke: A narrative review of its description and the outcome of intervention". International Journal of Speech-Language Pathology 13 (2): 125–36. doi:10.3109/17549507.2011.524940. PMID 21480809

Authors:

[1] Duffy, J. Defining, Understanding, and Categorizing Motor Speech Disorders. In: Duffy, J. Motor Speech Disorders: Substrates, Differential Diagnosis, and Management. 3rd ed. . St. Louis, Mo: Elsevier Mosby; 2012 ISBN 0323024521.

[2] MacKenzie, C (2011). "Dysarthria in stroke: A narrative review of its description and the outcome of intervention". International Journal of Speech-Language Pathology 13 (2): 125–36. doi:10.3109/17549507.2011.524940. PMID 21480809

[1]

[2]

@@ Line 1: / Line 1: @@
 ==Background==
 *Motor speech disorder characterized by poor articulation of language sounds or pronounciation<ref> Duffy, J. Defining, Understanding, and Categorizing Motor Speech Disorders. In: Duffy, J. ''Motor Speech Disorders: Substrates, Differential Diagnosis, and Management.'' 3rd ed. . St. Louis, Mo: Elsevier Mosby; 2012 ISBN 0323024521.</ref>
+*Cranial nerves involved include trigeminal nerve's motor branch (V), facial nerve (VII), glossopharyngeal nerve (IX), vagus nerve (X), and hypoglossal nerve (XII).
 ==Clinical Features==
+*Includes abnormality to any of the following: breath control, '''duration of syllables''', pitch, range, speed, steadiness, '''timing''', tone, '''vocal quality''', pitch, volume<ref>MacKenzie, C (2011). "Dysarthria in stroke: A narrative review of its description and the outcome of intervention". International Journal of Speech-Language Pathology 13 (2): 125–36. doi:10.3109/17549507.2011.524940. PMID 21480809</ref>
 ==Differential Diagnosis==
+===Stroke Types===
+*[[Ischemic Stroke]]
+**[[Cerebellar Stroke]]
+**[[Transient Ischemic Attack (TIA)]]
+*[[Hemorrhagic Stroke]]
+**[[Intracerebral Hemorrhage]]
+**[[Subarachnoid Hemorrhage (SAH)]]
-==Diagnosis==
+===[[Weakness]]===
+'''Neuromuscular weakness'''
+*UMN:
+***[[CVA (Main)]]
+***[[Hemorrhagic stroke]]
+***[[Multiple sclerosis]]
+***[[Amyotrophic Lateral Sclerosis (ALS)]] (UMN & LMN)
+**Spinal cord disease:
+***Infection ([[Epidural Abscess (Spinal)]])
+***Infarction/ischemia
+***Trauma ([[Spinal Cord Syndromes]])
+***Inflammation ([[Transverse Myelitis]])
+***Tumor
+**Peripheral nerve disease:
+***Lyme disease
+***[[Guillain-Barre syndrome]]
+***Toxins ([[Ciguatera]])
+***[[Tick paralysis]]
+***[[Diabetes mellitus]] neuropathy (non-emergent)
+**NMJ disease:
+***[[Myasthenia gravis]] crisis
+***[[Botulism]]
+***[[Organophosphate toxicity]]
+***[[Lambert-Eaton myasthenic syndrome]]
+**Muscle disease:
+***[[Rhabdomyolysis]]
+***[[Dermatomyositis]]
+***[[Polymyositis]]
+***Alcoholic myopathy
+*'''Non-neuromuscular weakness'''
+**Can't miss diagnoses:
+***[[Sepsis (Main)]]
+***[[Hypoglycemia]]
+***Periodic paralysis (electrolyte disturbance, K, Mg, Ca)
+****[[Hypokalemic periodic paralysis]]
+****[[Thyrotoxic periodic paralysis]]
+***Respiratory failure
+**Other
+***[[Cerebral palsy]]
+***[[Hypothermia]]
+***[[Parkinson's disease]]
+==Evaluation==
+*Clinical diagnosis
+*Consider [[CVA]] or other neurologic workup
 ==Management==
+*Treat underlying cause
+*Speech pathology
 ==Disposition==
+*Depends on underlying cause
 ==See Also==
-==External Links==
 ==References==
 <references/>
+[[Category:Neurology]]
+[[Category:ENT]]
+[[Category:Symptoms]]