Lecture 11: Differential Diagnosis

Question 1

(B)UMN damage : ___ :: UUMN damage : UUMN dysarthria

Answer 1

spastic dysarthria

Question 2

___ damage : flaccid dysarthria

Answer 2

LMN

Question 3

___ damage : ataxic dysarthria

Answer 3

cerebellar

Question 4

___ damage : hypo-hyperkinetic dysarthrias

Answer 4

basal ganglia

Question 5

flaccid and ataxic dysarthria are not associated with ___ lesions (2)

Answer 5

supratentorial (subcortical) lesions or anterior-medial-posterior cerebral arteries

Question 6

hypokinetic dysarthria only associate with ___ lesions

Answer 6

supratentorial (subcortical) lesions

Question 7

___ lesions can cause any type of dysarthria except hypokinetic dysarthria (2)

Answer 7

posterior fossa lesions and lesions in the distribution of the vertebrobasilar system

Question 8

___ lesions are only associated with flaccid dysarthria

Answer 8

spinal and peripheral (LMN) lesions

Question 9

etiology : vascular

Answer 9

common cause of UUMN and flaccid; less common: hyperkinetic

Question 10

etiology : degenerative disease

Answer 10

common cause of ALS (spastic and flaccid), parkinson’s (hypokinetic), and ataxic; less common: UUMN and hyperkinetic

Question 11

etiology : TBI

Answer 11

common cause of spastic (closed-head injury) and flaccid (skull fracture, neck trauma)

Question 12

etiology : surgical trauma

Answer 12

common cause of flaccid (ENT and cardiac surgeries); CNS and PNS dysarthrias (neurosurgery)

Question 13

etiology : toxic / metabolic

Answer 13

most commonly associated with hyperkinetic or ataxic

Question 14

etiology : demyelinating disease

Answer 14

common cause of flaccid (guillain-barre syndrome) and ataxic (MS)

Question 15

etiology : anatomic malformations

Answer 15

e.g. arnold-chiari, syringobulbia, and syringomelia

usually associated with flaccid; also associated with spastic and ataxic

Question 16

etiology : neuromuscular junction disorder

Answer 16

flaccid; e.g. PNS conditions (NMJ disorders, muscle diseases, neuropathies)

Question 17

OME pearls : flaccid

Answer 17

unique to flaccid : atrophy-fasciculations :: common to flaccid : hypotonia-hyporeflexia

Question 18

OME pearls : spastic (3)

Answer 18

common to spastic : pathological oral reflexes, hyperactive gag, pseudobulbar effect

Question 19

OME pearls : ataxic

Answer 19

common to ataxic : normal findings :: unique to ataxic : dysmetric jaw-face-lingual movements

Question 20

OME pearls : hypokinetic (3)

Answer 20

common to hypo : facial masking, orofacial tremulousness and reduced ROM on non speech AMRs

Question 21

OME pearls : hyperkinetic

Answer 21

confirmatory signs of hyper : quick-or-slow / patterned-or-unpatterned movement (at rest or during sustained postures) or AMRs

Question 22

OME pearls : UUMN

Answer 22

common to UUMN : unilateral lower facial / lingual weakness without atrophy-fasciculations

Question 23

you may see unilateral findings in ___ dysarthria but not usually other MSDs (2)

Answer 23

UUMN and flaccid dysarthria

Question 24

speech pearls : flaccid

Answer 24

unique to flaccid : phonatory-resonatory abnormalities :: flaccid with CN X px : breathiness, diplophonia, audible inspirations, and short phrases :: unique to flaccid : audible nasal emissions and nasal snorting

Question 25

___ can occur in spastic and hypokinetic but is usually more pronounced in flaccid

Answer 25

hypernasality

Question 26

speech pearls : spastic (3)

Answer 26

spastic hallmarks : slow speech rate, slow-steady AMRs, strained vocal quality

Question 27

strained voice can occur in ___ dysarthria but is NOT associated with slow rate

Answer 27

hyperkinetic

Question 28

slow rate is not uncommon in other MSDs but is NOT usually accompanied by ___

Answer 28

strained vocal quality

Question 29

speech pearls : ataxic (3*)

Answer 29

ataxic hallmarks : IRREGULAR articulatory breakdowns during connected speech, irregular AMRs and dysprosody

*also seen in UUMN and hyper EXCEPT hyperkinesias are not seen in ataxic and UUMN is usually accompanied by lower facial-tongue weakness

Question 30

speech pearls : hypokinetic

Answer 30

common to hypo : mono pitch-loudness, reduced loudness and stress, rapid tendencies and blurred AMRs

Question 31

the only MSD where accelerated rate occurs is in ___

Answer 31

hypokinetic dysarthria (but not always present)

Question 32

speech pearls : hyperkinetic

Answer 32

key characteristics : unpredictable and variably involuntary movements affecting speech

Question 33

the MSD where visual observation of involuntary movements is most useful / diagnostic

Answer 33

hyperkinetic dysarthria

Question 34

hyperkinetic dysarthria is the only MSD where ___

Answer 34

abnormal noises can interfere with speech or be produced at rest

Question 35

speech pearls : UUMN

Answer 35

UUMN hallmarks : mildness and nebulous speech abnormalities

*speech AMRs are uaully regular but some irregularity during connected speech