title: Acute isolated dysarthria is associated with a high risk of stroke.
abstract: 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 <1 week prior to presentation without an established nonvascular etiology. The primary outcome was a subsequent stroke within 90 days of the index visit. The secondary outcomes were the rate of TIA, myocardial infarction, and death. Isolated dysarthria was defined as slurring with imprecise articulation but without evidence of language dysfunction. The overall rate of stroke in this cohort was compared with that predicted by the median ABCD2 score for this group.
  
  
  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.
authors.affiliation: Division of Neurology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont., Canada.
authors.forename: Alina
authors.initials: A
authors.lastname: Beliavsky
authors.affiliation: Department of Emergency Medicine, Ottawa Hospital Research Institute, Ottawa, Ont., Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont., Canada.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Perry
authors.affiliation: Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, Ottawa, Ont., Canada ; Division of Neurology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont., Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont., Canada.
authors.forename: Dar
authors.initials: D
authors.lastname: Dowlatshahi
authors.affiliation: Division of Neurology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont., Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Wasserman
authors.affiliation: Department of Emergency Medicine, Queen's University, Kingston, Ont., Canada ; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ont., Canada.
authors.forename: Marco L A
authors.initials: ML
authors.lastname: Sivilotti
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont., Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: Sutherland
authors.affiliation: Division of Emergency Medicine, McMaster University, Hamilton, Ont., Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Worster
authors.affiliation: Department of Emergency and Family Medicine, Université Laval, Quebec, Que., Canada.
authors.forename: Marcel
authors.initials: M
authors.lastname: Emond
authors.affiliation: Division of Neurology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont., Canada.
authors.forename: Grant
authors.initials: G
authors.lastname: Stotts
authors.affiliation: Division of Neurology, Queen's University, Kingston, Ont., Canada.
authors.forename: Albert Y
authors.initials: AY
authors.lastname: Jin
authors.affiliation: Division of Neurology, McMaster University, Hamilton, Ont., Canada.
authors.forename: Wieslaw J
authors.initials: WJ
authors.lastname: Oczkowski
authors.affiliation: Division of Neurology, McMaster University, Hamilton, Ont., Canada.
authors.forename: Demetrios J
authors.initials: DJ
authors.lastname: Sahlas
authors.affiliation: Department of Emergency Medicine, Queen's University, Kingston, Ont., Canada.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Murray
authors.affiliation: Department of Neurology, Hôpital de l'Enfant-Jésus, Quebec City, Quebec, Que., Canada.
authors.forename: Ariane
authors.initials: A
authors.lastname: MacKey
authors.affiliation: Department of Neurology, Hôpital de l'Enfant-Jésus, Quebec City, Quebec, Que., Canada.
authors.forename: Steve
authors.initials: S
authors.lastname: Verreault
authors.affiliation: Department of Epidemiology and Community Medicine, Ottawa Hospital Research Institute, Ottawa, Ont., Canada.
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
authors.affiliation: Department of Emergency Medicine, Ottawa Hospital Research Institute, Ottawa, Ont., Canada ; Division of Neurology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont., Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont., Canada.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont., Canada ; Division of Neurology, McMaster University, Hamilton, Ont., Canada.
authors.forename: Mukul
authors.initials: M
authors.lastname: Sharma
keywords: Dysarthria; Outcome; Risk stratification; Stroke; Transient ischemic attack