DYSARTHRIA

DYSARTHRIA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the following questions:

1. Is it intermittent? Intermittent dysarthria should make one think of myasthenia gravis, epilepsy, and transient ischemic attacks.
2. Is there associated ataxia or nystagmus? The findings of nystagmus or ataxia should make one think of a cerebellar disorder such as multiple sclerosis, drug intoxication, or cerebellar ataxia.
3. Is there a history of drug or alcohol ingestion? Alcohol and phenytoin (Dilantin®) are just two of the toxic substances that may affect speech.
4. Is there tremor or rigidity? If there is tremor or rigidity, one should suspect Parkinson's disease, hepatolenticular degeneration, and phenothiazine toxicity.

DIAGNOSTIC WORKUP

The yield for diagnoses of dysarthria is high for a blood alcohol level and urine drug screen. If the dysarthria is intermittent, an EEG and Tensilon test or acetylcholine receptor antibody titer should be done. If transient ischemic attacks are suspected, a carotid scan should be done, but the only way to completely exclude this possibility is by doing four-vessel cerebral angiography. A CT scan or MRI should be done in all cases of persistent dysarthria. A neurologist can help decide which study would be most appropriate. If Wilson's disease is suspected, a test for serum copper and ceruloplasmin should be done. A spinal tap may help diagnose multiple sclerosis and intracranial hemorrhage.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 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: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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