Dysarthria

Dysarthria: Excerpt from In a Page: Signs and Symptoms

Dysarthria implies poor speech articulation, as opposed to aphasia or impoverished intelligence due to mental retardation or dementia. Pain is not a feature of dysarthria, nor is poor education. Speech and reading comprehension are completely unaffected in pure dysarthria. Speech therapy is an essential part of treatment to prevent aspiration and optimize communication.

Differential Diagnosis

• Neurological causes
  –Lesions of upper motor neurons: Stroke, tumor, abscess, degeneration (e.g., Parkinson's disease); voluntary motor pathways to cranial nerve nuclei 9, 10, and 12 are affected
  –Lesions of lower motor neuron: Brainstem stroke, amyotrophic lateral sclerosis, hypothyroidism, diabetic nerve infarction
  –Lesions of the neuromuscular junction: Myasthenia gravis, prolonged effects of anesthesia, botulism, nerve gas/ organophosphate poisoning; all cause oropharyngeal or glossal weakness
  –Lesions of muscle: Polymyositis, dermatomyositis, inherited muscle diseases such as myotonic muscular dystrophy, mitochondrial diseases
• Structural causes
  –Tumors of the lips, tongue, squamous cell epithelium of the vocal cords and oropharynx
  –Polyps or salivary gland dysfunction resulting in xerostomia (dry mouth)
  –Hypoglossal nerve damage due to surgical traction from carotid endarterectomy
• Less common etiologies include glossitis (amyloidosis, hypothyroidism, anaerobic infection), acute dystonic reaction, unrecognized foreign accent, mild cerebral palsy, sedative/anticonvulsant intoxication, poor dentition or ill-fitting dentures, cleft palate

Workup and Diagnosis

• History and physical examination, with focus on past medical history and a comprehensive ENT and neurologic exam
• Upper motor neuron lesions: Cerebral imaging (especially MRI) is indicated to distinguish ischemic from hemorrhagic infarction, and an abscess from a tumor
• Lower motor neuron lesions: MRI is vastly superior to CT; labs may include TSH, glucose tolerance testing, and toxicology screen in patients with suspected metabolic causes or sedative drug intoxication
• EMG with nerve conduction tests is indicated in suspected cases of ALS
• Neuromuscular junction lesions often present with fluctuations of dysarthria; myasthenia gravis antibody testing may be indicated; ECG and telemetry are indicated in various poisonings
• Muscle lesions: Genetic testing for heritable causes; creatine phosphokinase level and EMG testing for acquired causes
• Structural causes: Proper ENT examination with indirect laryngoscopy and MRI of the oropharynx if masses are suspected or palpated

Treatment

• Speech therapy is often necessary to relearn oral movements and communication skills, prevent aspiration, and motivate the patient
• Treat underlying etiologies as necessary
  –ALS does not improve
  –Dysarthria may improve with treatment of diabetes and/or hypothyroidism
  –Myasthenia gravis improves with pyridostigmine and immunosuppression
  –Pralidoxime and atropine for nerve gas poisoning
  –Antitoxin and close ICU observation for botulism
  –Steroids for polymyositis and dermatomyositis
• Surgical intervention may be necessary for structural causes

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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