Case 17 - Slurred speech
Case
A 70 year old man noted changes in his speech.
He couldn’t recall an exact time it had changed, but it had become apparent to him over the last 2-3 weeks, and his relatives had commented. It was harder to clearly articulate certain words clearly, and his speech seemed slurred.In addition, his tongue had become deviated to the left in his mouth, and he had difficulty moving it normally or sticking it out. It had become awkward to move food around and initiate swallowing, although he had no issues with choking or regurgitating food.
He had been having minor headaches for the last 4 weeks which were left sided and non-specific in nature, with no features of raised intracranial pressure, migraine, giant cell arteritis or any other individual diagnosis, and not any worse on neck movement.
There were no other symptoms, including any problems with swallowing, changes to his voice, difficulty with neck movements, or symptoms in the limbs. He had no neck pain. He felt systemically well.
Past medical history included non-metastatic rectal cancer treated with surgery and chemotherapy two years previously. There was no recent history of trauma or neck manipulation.
On examination:
Otherwise he had no other cranial nerve deficits. Limb tone, power, reflexes, coordination and sensation were normal, as was gait.