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Has speech impairment, sounds like tongue is tied. Had mild stroke but neurological check was fine. Suggest?

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My mother, who is 81 and in fairly good health has developed this speech impairment. She had a mild stroke 2 years ago but with a detailed neurological check was fine. Since this past April she sounds as if her tongue is tied or almost paralyzed, especially after she eats.
She has an appointment with her Neurologist on the 3rd of September, but she thinks it may have something to do with a scleroderma esophageal motility problem? this diagnosis came from her GI Dr.
Many thanks , XXXXXXX
Posted Sat, 14 Sep 2013 in Stroke
Answered by Dr. Sumit Bhatti 1 hour later
Brief Answer:
Hypoglossal nerve paresis, Cortical lesion

Detailed Answer:

Thank you for your query.

1. This may be a Hypoglossal (Twelfth Cranial Nerve) palsy.

2. If the tongue is healthy but deviates to one side on protrusion, then it may be an Upper Motor Neuron (UMN or Cortical) lesion. The deviation would be opposite to the side of the stroke. (In a Lower Motor Neuron or local injury, the tongue deviated to the same side and there is atrophy of one side of the tongue)

3. This would cause dysarthria and slurring of speech. As the normal side compensates, she would worsen after a meal as the normal side fatigues.

4. Esophageal Scleroderma may cause dysphagia (difficulty in swallowing) and will not affect the tongue unless it is part of the CREST Syndrome.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

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