Cerebrovascular Diseases Extra (Aug 2014)

Acute Isolated Dysarthria Is Associated with a High Risk of Stroke

  • Alina Beliavsky,
  • Jeffrey J. Perry,
  • Dar Dowlatshahi,
  • Jason Wasserman,
  • Marco L.A. Sivilotti,
  • Jane Sutherland,
  • Andrew Worster,
  • Marcel Émond,
  • Grant Stotts,
  • Albert Y. Jin,
  • Wieslaw J. Oczkowski,
  • Demetrios J. Sahlas,
  • Heather E. Murray,
  • Ariane MacKey,
  • Steve Verreault,
  • George A. Wells,
  • Ian G. Stiell,
  • Mukul Sharma

DOI
https://doi.org/10.1159/000365169
Journal volume & issue
Vol. 4, no. 2
pp. 182 – 185

Abstract

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Background: Isolated dysarthria is an uncommon presentation of transient ischemic attack (TIA)/minor stroke and has a broad differential diagnosis. There is little information in the literature about how often this presentation is confirmed to be a TIA/stroke, and therefore there is debate about the risk of subsequent vascular events. Given the uncertain prognosis, it is unclear how to best manage patients presenting to the emergency department (ED) with isolated dysarthria. The objective of this study was to prospectively identify and follow a cohort of patients presenting to EDs with isolated dysarthria in order to explore their natural history and risk of recurrent cerebrovascular events. Specifically, we sought to determine early outcomes of individuals with this nonspecific and atypical presentation in order to appropriately expedite their management. Methods: Patients with isolated dysarthria having presented to 8 Canadian EDs between October 2006 and April 2009 were analyzed as part of a prospective multicenter cohort study of patients with acute neurological symptoms as assessed by emergency physicians. The study inclusion criteria were age ≥18 years, a normal level of consciousness, and a symptom onset Results: Between 2006 and 2009, 1,528 patients were enrolled and had a 90-day follow-up. Of these, 43 patients presented with isolated acute-onset dysarthria (2.8%). Recurrent stroke occurred in 6/43 (14.0%) within 90 days of enrollment. The predicted maximal 90-day stroke rate was 9.8% (based on a median ABCD2 score of 5 for the isolated dysarthria cohort). After adjusting for covariates, isolated dysarthria independently predicted stroke within 90 days (aOR: 3.96; 95% CI: 1.3-11.9; p = 0.014). Conclusions: The isolated dysarthria cohort carried a recurrent stroke risk comparable to that predicted by the median ABCD2 scores. Although isolated dysarthria is a nonspecific and uncommon clinical presentation of TIA, these findings support the need to view it first and foremost as a vascular presentation until proven otherwise and to manage such patients as if they were at high risk of stroke in accordance with established high-risk TIA guidelines.

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