Differential Diagnosis

Question 1

Vascular

Answer 1

Vascular- most often cause spastic, UUMN, and ataxic. Hemorrhagic stroke is the most common cause of dysarthria.

Question 2

Degenerative

Answer 2

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.

Question 3

TBI

Answer 3

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.

Question 4

Surgical trauma

Answer 4

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.

Question 5

Toxic and metabolic conditions

Answer 5

do not typically cause flaccid or UUMN dysarthria. Toxic conditions associated with drugs/medications cause hyperkinetic and ataxic dysarthrias most often.

Question 6

Demyelinating diseases

Answer 6

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.

Question 7

Anatomic malformations/ Arnold-Chiari

Answer 7

Anatomic malformations such as Arnold Chiari (malformations of the brain) are most often associated with flaccid dysarthria.

Question 8

Neuromuscular junction disorders

Answer 8

Myasthenia Gravis a neuromuscular junction disorder only cause flaccid dysarthria because they are PNS diseases.

Question 9

Dysarthria

Answer 9

Dysarthria can be present in the absence of any neurological diagnosis. Sometimes the etiology is undetermined specifically for spastic, ataxic, and hyperkinetic.

Question 10

Oral mechanism Findings

Answer 10

Certain findings in the oral mechanism are not required for MSD but are used as confirmatory signs.

Question 11

Flaccid dysarthria

Answer 11

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.

Question 12

Spastic dysarthria

Answer 12

pathological oral reflexes, hyperactive gag reflex and pseudobulbar effect. Also more problems exist with dysphagia and drooling than other MSD’s.

Question 13

Ataxic dysarthria

Answer 13

may have dysmetria in non speech jaw, face, and tongue movements. Other oral mechanism findings may be normal

Question 14

Hypokinetic dysarthria

Answer 14

orofacial tremors and masked expression

Question 15

Hyperkinetic dysarthria

Answer 15

abnormal movements may be seen both at rest and in speech that are not seen in other dysarthrias.

Question 16

UUMN dysarthria

Answer 16

unilateral facial and lingual weakness without atrophy and fasciculations

Question 17

Flaccid dysarthria

Answer 17

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.

Question 18

Spastic dysarthria

Answer 18

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.

Question 19

Ataxic dysarthria

Answer 19

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.

Question 20

Hypokinetic dysarthria

Answer 20

the only dysarthria with rapid or blurred speech and AMR’s. If palilalia occurs it only occurs with hypo kinetic dysarthria.

Question 21

UUMN

Answer 21

wet gurgle voice and vocal flutter

Question 22

Apraxia

Answer 22

Apraxia occurs in left hemisphere damage except when there is right hemisphere language dominance or mixed dominance. It occurs with supratentorial damage.

Question 23

Dysarthria

Answer 23

Dysarthria occurs with supratentorial (anterior and middle fossae), posteria fossa, spinal or peripheral lesions.

Question 24

Apraxia

Answer 24

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.

Question 25

apraxia vs. dysarthria

Answer 25

in dysarthria all subsystems are affected. AOS-mainly articulation and prosody are affected. AOS is most often associated with aphasia than dysarthria. Apraxia speakers grope, dysarthria speakers do not.

Question 26

dysarthria vs. aphasia

Answer 26

aphasia pts can have normal oral mechanism- dysarthria patients do not have language problems.

Question 27

Neurogenic mutism

Answer 27

conditions that have diffuse or multifocal damage are more likely to be associated with mutism due to cognitive-affective disturbances than with anarthria, AOS, aphasia.

Question 28

Anarthria

Answer 28

Anarthria is lack of speech- usually have dysphagia and other oromotor abnormalities and this helps dx. Rarely does anarthic mutism occur in absence of non speech oromotor difficulties. When attempting to speak, their restricted articulatory ROM, reduced loudness and strained, groaning quality is diagnostic. Mutism related to apraxia can be associated with normal findings in oral mech. Mute apraxic pts usually try to speak and show frustration when they can’t. mutism due to aphasia-similar to mute apraxic pts except they may have problems following instructions. if mutism is present, aphasia is usually severe so they do poorly on language test. Cognitive-affective disturbances- may be due to reduced arousal or alertness. If speech does eventually occur, there are delays with brief unelaborated speech.

Question 29

Differential diagnosis

Answer 29

differential diagnosis is the process of narrowing possibilities and reaching conclusions about the nature of a deficit.

Question 30

Differential diagnosis

Answer 30

Reasons for not being able to make a diagnosis include: noncooperative patient or equivocal/uncertain findings