Differential Diagnosis Flashcards
Vascular
Vascular- most often cause spastic, UUMN, and ataxic. Hemorrhagic stroke is the most common cause of dysarthria.
Degenerative
Most often it causes spastic, ataxic, hypokinetic and flaccid dysarthrias. ALS is a frequent cause of flaccid & spastic but other types of dysarthrias are not usually seen in ALS, so if there is another type of dysarthria existing, there may be another disease or the diagnosis of ALS may be in error.
TBI
Central nervous system dysarthrias- in a closed headed injury the most common type is spastic. OHI can cause spastic, ataxic, and UUMN. Skull fracture and neck traumas can cause flaccid dysarthria, but not other types.
Surgical trauma
Surgical trauma can cause any type of dysarthria except hypokinetic. Surgeries involved with ear, nose throat, chest/cardiac areas are associated with flaccid dysarthria. Neurosurgery can cause CNS dysarthrias as well as flaccid dysarthria.
Toxic and metabolic conditions
do not typically cause flaccid or UUMN dysarthria. Toxic conditions associated with drugs/medications cause hyperkinetic and ataxic dysarthrias most often.
Demyelinating diseases
can cause any dysarthria but hypokinetic is rare. The type of dysarthria depends on the disorder, Guillan Barre disease is usually associated with flaccid whereas MS is usually associated with ataxic dysarthria.
Anatomic malformations/ Arnold-Chiari
Anatomic malformations such as Arnold Chiari (malformations of the brain) are most often associated with flaccid dysarthria.
Neuromuscular junction disorders
Myasthenia Gravis a neuromuscular junction disorder only cause flaccid dysarthria because they are PNS diseases.
Dysarthria
Dysarthria can be present in the absence of any neurological diagnosis. Sometimes the etiology is undetermined specifically for spastic, ataxic, and hyperkinetic.
Oral mechanism Findings
Certain findings in the oral mechanism are not required for MSD but are used as confirmatory signs.
Flaccid dysarthria
Atrophy and fasciculations often occur in FD and do not occur in other dysarthrias or apraxia. Hypotonia and hypoactive gag reflex. Rapid loss of intelligibility is indicative of myasthenia gravis. Nasal regurgitation may be seen in FD.
Spastic dysarthria
pathological oral reflexes, hyperactive gag reflex and pseudobulbar effect. Also more problems exist with dysphagia and drooling than other MSD’s.
Ataxic dysarthria
may have dysmetria in non speech jaw, face, and tongue movements. Other oral mechanism findings may be normal
Hypokinetic dysarthria
orofacial tremors and masked expression
Hyperkinetic dysarthria
abnormal movements may be seen both at rest and in speech that are not seen in other dysarthrias.
UUMN dysarthria
unilateral facial and lingual weakness without atrophy and fasciculations
Flaccid dysarthria
phonatory and resonatory are most common distinguishing features-hypernasality is most pronounced in FD. If the Xth nerve is affected you may see breathiness, diplophonia, audible inspiration and short phrases. Breathiness does occur in hypo kinetic dysarthria but listen for greater hoarseness and diplophonia. Rapid deterioration of speech occurs only in connection with myasthenia gravis.
Spastic dysarthria
slow rate combined with slow but regular AMR’s, strained voice quality are most common features. It is the presence of all three that is not typical in other dysarthrias.
Ataxic dysarthria
irregular articulatory breakdowns, irregular AMR’s and dysprosody. You may also hear these in UUMN and hyperkinetic dysarthria but to distinguish look for abnormal movements in hyperkinetic dysarthria and unilateral lower f facial and tongue weakness in UUMN.
Hypokinetic dysarthria
the only dysarthria with rapid or blurred speech and AMR’s. If palilalia occurs it only occurs with hypo kinetic dysarthria.
UUMN
wet gurgle voice and vocal flutter
Apraxia
Apraxia occurs in left hemisphere damage except when there is right hemisphere language dominance or mixed dominance. It occurs with supratentorial damage.
Dysarthria
Dysarthria occurs with supratentorial (anterior and middle fossae), posteria fossa, spinal or peripheral lesions.
Apraxia
Apraxia occurs primarily with lesions to the carotid system. Dysarthria not only occurs with carotid lesions but with other vascular system lesions. UUMN is the most difficult to differentiate from AOS.
