Comprehensive Assessment of Acute Isolated or Prominent Dysarthria in the Emergency Department: A Neuro-Emergency Expert's Experience beyond Stroke

Abstract

We investigated the clinical characteristics, neuroimaging findings, and final diagnosis of patients with acute isolated or prominent dysarthria who visited the emergency department (ED) between 1 January 2020 and 31 December 2021. Of 2028 patients aged ≥ 18 years with neurologic symptoms treated by a neuro-emergency expert, 75 with acute isolated or predominant dysarthria within 1 week were enrolled. Patients were categorized as having isolated dysarthria (n = 28, 37.3%) and prominent dysarthria (n = 47, 62.7%). The causes of stroke were acute ischemic stroke (AIS) (n = 37, 49.3%), transient ischemic attack (TIA) (n = 14, 18.7%), intracerebral hemorrhage (n = 1, 1.3%), and non-stroke causes (n = 23, 30.7%). The most common additional symptoms were gait disturbance or imbalance (n = 8, 15.4%) and dizziness (n = 3, 13.0%) in the stroke and non-stroke groups, respectively. The isolated dysarthria group had a higher rate of TIA (n = 7, 38.9%), single and small lesions (n = 10, 83.3%), and small-vessel occlusion in Trial of Org 101072 in acute stroke treatment (n = 8, 66.7%). Acute isolated or prominent dysarthria in the ED mostly presented as clinical symptoms of AIS, but other non-stroke and medical causes were not uncommon. In acute dysarthria with ischemic stroke, multiple territorial and small and single lesions are considered a cause.

Keywords: dysarthria; emergency department; ischemic stroke.

Figure 1

Flow diagram of enrolled patients during the study period (1 January 2020 to 31 December 2021). ^a. Two patients were diagnosed with multiple sclerosis and multiple cranial neuropathies. ^b. One patient’s diagnosis was changed to focal seizures.

Figure 2

Clinical characteristics and neuroimaging findings of patients with ischemic stroke or TIA presenting with dysarthria only. Except for the bottom two cases, all showed a single lesion on DWI.

Figure 2

Clinical characteristics and neuroimaging findings of patients with ischemic stroke or TIA presenting with dysarthria only. Except for the bottom two cases, all showed a single lesion on DWI.

Figure 3

Clinical characteristics and neuroimaging findings of patients with ischemic stroke or TIA presenting with prominent dysarthria and small and single lesions.

Figure 3

Clinical characteristics and neuroimaging findings of patients with ischemic stroke or TIA presenting with prominent dysarthria and small and single lesions.

Figure 4

Clinical characteristics and neuroimaging findings of patients with ischemic stroke or TIA presenting with prominent dysarthria and multiple territorial lesions.

Figure 4

Clinical characteristics and neuroimaging findings of patients with ischemic stroke or TIA presenting with prominent dysarthria and multiple territorial lesions.