Dysarthria and Dysphagia

Authors: Flaherty, Alice W.; Rost, Natalia S.

Title: Massachusetts General Hospital Handbook of Neurology, The, 2nd Edition

Copyright 2007 Lippincott Williams & Wilkins

> Table of Contents > Adult Neurology > Dysarthria and Dysphagia

Dysarthria and Dysphagia

A. Dysarthria

Abnormal articulation, as opposed to aphasia.

• 1. H&P: Abnormal articulation, rhythm, or volume. Ask about diurnal fluctuations (suggests myasthenia), improvement with alcohol (suggests essential tremor). Assess palatal elevation when pt says a long a or coca-cola. Assess ability to hold a tone or sing. Look especially for other cranial nerve signs, dysmetria, tremor, dystonia, or spasticity.

• 2. Tests: MRI, laryngoscopy, consider EMG of orofacial muscles (hurts).

• 3. Causes: See also bulbar vs. pseudobulbar palsy, p. 129.

  • a. Peripheral: Flaccid. Myasthenia, polyneuritis, myopathy, cranial nerve lesions, maxillofacial lesions.

  • b. Central: Spastic (corticospinal tract damage), ataxic (cerebellar lesion), bradykinetic (parkinsonism), hyperkinetic (chorea, dystonia).

  • c. Mixed: Spastic-flaccid (ALS), spastic-ataxic (MS, Wilson's dz, encephalitis).

• 4. DDx:

  • a. Spasmodic dysphonia: Often associated with face or neck dystonia. Not present when whispering or singing.

    • 1) Abductor dysphonia: Choppy and strained; words drop out.

    P.39

    
    

    • 2) Adductor dysphonia: Breathy, whispery.

    • 3) Rx: Botulinum toxin.

  • b. Dysfluency: E.g., stuttering, palilalia. In frontal lesion, Parkinson's.

  • c. Other: Aphasia, stuttering, intoxication or delirium.

• 5. Rx: Treat underlying dz.

B. Dysphagia

Abnormal swallowing.

• 1. H&P: Choking, coughing after swallowing, weight loss, recurrent pneumonias. Is it worse with liquids or solids? Watch pt. swallow water, assess gag, other cranial nerves, motor exam.

• 2. Tests: Swallowing study (cine-esophogram). Brain scan. CXR if you suspect aspiration pneumonia.

• 3. Causes:

  • a. Neurological: Upper or lower motor neuron lesion (stroke, brainstem mass, etc.), ALS, neuropathy, MS, myasthenia, Chiari malformation, syringobulbia, myopathy, Parkinson's dz, spinocerebellar degeneration, tardive dyskinesia, cerebral palsy.

  • b. Nonneurological: Esophageal mass, scleroderma, achalasia, esophageal spasm, Sj gren's syndrome.

• 4. Rx: Aspiration precautions, swallowing therapy, dysphagia diets (e.g., purees), thickened liquids, nasogastric or gastric tube.