Hello, From the description of your message you seem to have good medical knowledge and I will use some medical terms more freely then I usually do- but do not worry, even if my assumption is wrong, you will understand my response the same. The symptoms reported are chiefly- slurred speech and muscle weakness in throat not allowing her to swallow- chiefly what is medically termed dysarthria and dysphagia, respectively. From your description, the symptoms are not persistent and come and go. And there is no stroke (so no UMN/brain related cause likely). In the given set of data, the possible causes left are: 1. Motor Neuron Disease. 2. Myasthenia Gravis. 3. Muscle disease. I think the most likely possibility is Myasthenia Gravis- because this is the only one of the 3 listed causes that is not continuous. The weakness in both other conditions is more or less permanent. A neostigmine / edrophonium test may be the best way to detect the presence of Myasthenia. If found to be positive, she may need a chest scan to look for thymoma. And medications- steroids with pyridostigmine (dose needs to be individualized to the patient) will need to be started. An EMG test and serum CPK levels may also be planned if neostigmine test is negative to detect the other 2 possibilities.Hypertension may be related to this condition and medications will be needed to be tailored accordingly as some medicines (such as betablockers, calcium channel blockers- 2 of the most commonly used antihypertensives) themselves can worsen and trigger a latent myasthenia. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Saumya Mittal , Diabetologist