Dysarthria

Background

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

Differential Diagnosis

Stroke Types

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

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