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Suggest Remedies For Slurred Speech And Difficulty In Swallowing
Question: Hi my name is XXXXXXX My brother in law is in his late 50s and has issues with slurred speach, he is drooling as well as he is having trouble swallowing. These symptoms came suddenly. He went to doctor and hospital. A brain scan was completed and everyone is saying he is alright but he does feel that way.
Brief Answer:
If only a brain scan it is not enough.
Detailed Answer:
I read your question carefully and I understand your concern.
It is unclear whether by brain scan you mean a CT or a MRI. If it's a CT it is not enough to exclude a central nervous system cause such as a brainstem stroke which may manifest with those symptoms, so a MRI with contrast administration is needed for that purpose.
If a MRI has been done, while it can exclude central nervous system issues it still leaves peripheral nervous system disorders, evaluation is far from complete. If the symptoms have developed gradually then ALS (amyotrophic lateral sclerosis) is a possibility. Some forms of Guillain Barre syndrome, an inflammation of nerve roots may also manifest with involvement of brainstem nerves. Myasthenia gravis is another possibility to be considered.
So I think a neurologist evaluation is certainly needed and some additional tests starting with nerve conduction studies and electromyography to search for peripheral nerves and muscle issues.
I remain at your disposal for other questions.
If only a brain scan it is not enough.
Detailed Answer:
I read your question carefully and I understand your concern.
It is unclear whether by brain scan you mean a CT or a MRI. If it's a CT it is not enough to exclude a central nervous system cause such as a brainstem stroke which may manifest with those symptoms, so a MRI with contrast administration is needed for that purpose.
If a MRI has been done, while it can exclude central nervous system issues it still leaves peripheral nervous system disorders, evaluation is far from complete. If the symptoms have developed gradually then ALS (amyotrophic lateral sclerosis) is a possibility. Some forms of Guillain Barre syndrome, an inflammation of nerve roots may also manifest with involvement of brainstem nerves. Myasthenia gravis is another possibility to be considered.
So I think a neurologist evaluation is certainly needed and some additional tests starting with nerve conduction studies and electromyography to search for peripheral nerves and muscle issues.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Read below
Detailed Answer:
I am a little confused. How can the doctors say that all is ok if you say in your initial query that he is having trouble swallowing, drooling and slurred speech. I understand about the impossibility of having an MRI, but they should provide an explanation for the symptoms if they are persisting.
If they were of an acute onset (please provide some more info on evolution of symptoms) I would manage him as a stroke as CT can't detect lesions in the area of the brain which deals with those functions, so stroke would remain the most likely cause even with a normal CT. So he should be investigated with imaging of the blood vessels, heart issues and some blood tests for metabolic alterations.
If they do not think it's a stroke they should conduct the nerve conduction studies and electromyography testing which I mentioned.
Read below
Detailed Answer:
I am a little confused. How can the doctors say that all is ok if you say in your initial query that he is having trouble swallowing, drooling and slurred speech. I understand about the impossibility of having an MRI, but they should provide an explanation for the symptoms if they are persisting.
If they were of an acute onset (please provide some more info on evolution of symptoms) I would manage him as a stroke as CT can't detect lesions in the area of the brain which deals with those functions, so stroke would remain the most likely cause even with a normal CT. So he should be investigated with imaging of the blood vessels, heart issues and some blood tests for metabolic alterations.
If they do not think it's a stroke they should conduct the nerve conduction studies and electromyography testing which I mentioned.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
About mid may 2016 a week after him mom died for dementia while listening to himself while he was speaking he noticed his speach got slightly slower. He thought it was temporary so he didn't think anything of it. About 2 to 3 weeks his speach got worse since his job sent him for an alcohol and drug screen due to they though he was using something. Which after they got his results all was clear. About another 2 weeks he stared drooling all the time so now when he speaks he has to keep a napkin at hand to wipe the drool down after he is done speaking. The most time he is drooling is when he is laying / sleeping. When he tries to lay on his back he feels like his breathing stops since he starts choking and can't catch a breath. So he can only sleep on his side. Now after several months he has to eat really slow and take small bites because otherwise he starts to choke. Now it is much worse due to her is a truck driver and when he went for a DOT inspection the DOT officer called highway patrol since they through the heart was drunk due to his speach. They conducted a breathalyzer test which he had no alcohol in the system at all. His job requires him to sit around 8 to 10 hours a day. For the past 2 months his feet started swelling and now it hit the ancles which the swelling is going up his legs I don't know if that has something to do with it but it is worring the family. We are all worried as well as he is if their is a treatment for this or not. He is scared that his time is limited due to these issues.
Brief Answer:
Read below.
Detailed Answer:
Hello again XXXXXXX Judging from that description a stroke is not likely with that progressive course.
It should be investigated in the direction of a peripheral nerve or muscle disorder like ALS, myasthenia etc. A CT scan is nowhere near enough in completing his evaluation and I am really puzzled by his doctors leaving it at that. He should have the EMG I mentioned above, if not seen by a neurologist already should be seen by one, he/you should insist with the doctors about pushing for a diagnosis. Without the appropriate tests I am afraid one can't draw any more conclusions.
Let me know if I can further assist you.
Read below.
Detailed Answer:
Hello again XXXXXXX Judging from that description a stroke is not likely with that progressive course.
It should be investigated in the direction of a peripheral nerve or muscle disorder like ALS, myasthenia etc. A CT scan is nowhere near enough in completing his evaluation and I am really puzzled by his doctors leaving it at that. He should have the EMG I mentioned above, if not seen by a neurologist already should be seen by one, he/you should insist with the doctors about pushing for a diagnosis. Without the appropriate tests I am afraid one can't draw any more conclusions.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you he will schedule an appointment with his neurologist.
Brief Answer:
Hope things work out for the best.
Detailed Answer:
Hope things work out for the best.
Hope things work out for the best.
Detailed Answer:
Hope things work out for the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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