Dysarthria

Background

• Motor speech disorder characterized by poor articulation of language sounds or pronounciation

Differential Diagnosis

Stroke Types

• Ischemic Stroke
  • Cerebellar Stroke
  • Transient Ischemic Attack (TIA)
• Hemorrhagic Stroke
  • Intracerebral Hemorrhage
  • Subarachnoid Hemorrhage (SAH)

Stroke-like Symptoms

• Stroke
• Seizures/postictal paralysis (Todd paralysis)
• Syncope
• Subdural hemorrhage
• Epidural hemorrhage
• Hypoglycemia
• Hyponatremia
• Meningitis/encephalitis
• Hyperosmotic Coma
• Labyrinthitis
• Drug toxicity
  • Lithium, phenytoin, carbamazepine
• Bell's Palsy
• Complicated migraine
• Meniere Disease
• Demyelinating disease (MS)
• Conversion disorder
• Transient global amnesia
• Giant cell arteritis
• Cerebral sinus thrombosis

• ===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:
    • Guillain-Barre syndrome
    • Toxins (Ciguatera)
    • Tick paralysis
    • DM 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