Evaluation Guidelines Table61

Speech and language disturbances are assessed by clinical history, bedside speech and language assessment, and neurological examination. Complementary investigations, such as neuroimaging, electrophysiology, fluid and tissue analysis, neuropsychological testing and other tests help confirm the clinical diagnosis.

Neuroimaging. Several techniques are extremely helpful for localizing and identifying various types of pathologies underlying a speech or language disturbance, or both. With the advent of CT and magnetic resonance imaging (MRI), the improved visualization of subcortical structures have implicated these regions in a growing number of speech and language disorders. Investigators have used positron emission tomography (PET) and single photon emission computed tomography (SPECT) to investigate aphasia and the anatomy of language. The studies have largely confirmed lesion-derived conclusions about the anatomy of language described earlier.y

Electrophysiology. Electroencephalography (EEG) measures one parameter of brain function and can help in the localization of pathology. Repetitive magnetic stimulation has been used to localize lesions within the language dominant hemisphere. y Electromyography (EMG) and nerve conductions studies could assist in the diagnosis of peripheral causes of speech disorders, including motor neuron disease, and disorders of the neuromuscular junction.

Cerebrospinal Fluid. Lumbar puncture, blood and urine analysis, as well as more invasive procedures such as brain biopsy may be performed to confirm a diagnosis and help in the treatment of the underlying pathology, particularly in patients with inflammatory or infectious disorders.

Neuropsychological Tests. Numerous tests provide valuable information about cognitive function, particularly in patients suspected of having a degenerative disease underlying their language disturbance. Severe aphasia makes it impossible to perform meaningful neuropsychological assessment.

Other Tests. Of additional value, laryngoscopy (direct and indirect) and diaphragmatic fluoroscopy can be helpful in the diagnosis of peripheral causes of speech disorders.

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