Trouble Speaking: Common Causes & When to See a Doctor

Stroke or tia (transient ischemic attack)

Transient ischemic attack, or TIA, is sometimes called a "mini stroke" or a "warning stroke." Any stroke means that blood flow somewhere in the brain has been blocked by a clot.

Risk factors include smoking, obesity, and cardiovascular disease, though anyone can experience a TIA.

Symptoms are "transient," meaning they come and go within minutes because the clot dissolves or moves on its own. Stroke symptoms include weakness, numbness, and paralysis on one side of the face and/or body; slurred speech; abnormal vision; and sudden, severe headache.

A TIA does not cause permanent damage because it is over quickly. However, the patient must get treatment because a TIA is a warning that a more damaging stroke is likely to occur. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through patient history; physical examination; CT scan or MRI; and electrocardiogram.

Treatment includes anticoagulant medication to prevent further clots. Surgery to clear some of the arteries may also be recommended.

Rarity: Common

Top Symptoms: dizziness, leg numbness, arm numbness, new headache, stiff neck

Symptoms that never occur with stroke or tia (transient ischemic attack): bilateral weakness

Urgency: Emergency medical servic

Neck injury

Neck sprain, sometimes called "whiplash," means that the ligaments – the tough, fibrous bands that connect bones together – in the neck have been torn or overstretched.

It is caused by a sudden impact that causes the head to whip back and forth very suddenly, most commonly from an automobile accident or riding a fast amusement park ride. A sports injury may force the neck to overstretch, spraining the ligaments.

Symptoms include pain and stiffness in the neck, shoulders, and upper back; dizziness; ringing in the ears; and sometimes spots of numbness in the hands and arms.

It is important to see a medical provider about these symptoms, to rule out any damage to the spinal cord. Paralysis, difficulty walking, or loss of control over bladder and bowels indicate a medical emergency. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through physical examination, tests of reflexes, and sometimes x-ray, CT scan, or MRI.

Treatment includes rest and over-the-counter nonsteroidal anti-inflammatory drugs to ease pain and reduce inflammation. Muscle relaxants may be prescribed.

Laryngitis

Laryngitis an inflammation of the larynx, or voice box. This causes the vocal cords to swell and leads to a hoarse, raspy voice.

A viral infection, such as the common cold or influenza, is nearly always the cause of laryngitis. These infections are spread through casual contact, as when someone sneezes and the droplets are inhaled from the air.

Most at risk are people whose immune systems are already weakened by illness, medication, or chemotherapy.

Symptoms include hoarseness; sore, irritated throat; difficulty speaking; coughing; and sometimes fever.

Forcing speech during laryngitis can cause permanent damage to the vocal cords. Hoarseness that never really clears up should be seen by a medical provider, as it can be a symptom of a more serious condition.

Diagnosis is made through throat swab and sometimes blood tests.

Treatment involves rest and drinking plenty of fluids until the virus has run its course, and resting the voice so the swelling can subside on its own. Antibiotics are not effective against a viral illness.

Carotid artery dissection

A carotid artery dissection is the tearing of the walls of the carotid arteries, which deliver blood to the brain from the aorta. This is a medical emergency.

Call 911 immediately. Diagnosis is done by CT or MRI, and treatment involves anti-clotting medication for at least 3-6 months. Surgery may be necessary for those who can't get this medication.

Brain tumor or mass

In medical terms, "mass" and "tumor" mean the same thing: the unexplained, out-of-place growth of tissue anywhere in the body, including the brain.

The cause of any sort of brain tumor is unknown. Some originate in the brain, while others spread from cancers growing in other parts of the body.

Symptoms may include increasing headaches; nausea and vomiting; blurred or double vision; loss of sensation in an arm or leg; loss of balance; confusion; speech difficulties; or seizures.

If symptoms persist, it is important to see a medical provider so that any treatment can begin as soon as possible.

Diagnosis is made through neurological examination, CT scan, and/or MRI.

If the mass or tumor is found to be benign, that means it is not cancer and not harmful. It may or may not be treated.

If it is malignant, that means it is cancer and must be treated. This will involve some combination of surgery, radiation therapy, and chemotherapy, followed by specialized therapy to help with recovery.

Rarity: Rare

Top Symptoms: fatigue, headache, nausea, loss of appetite, irritability

Symptoms that always occur with brain tumor or mass: focal neurological symptoms

Urgency: In-person visit

Anxiety

Anxiety causes intense worry or fear, and can also cause physical symptoms like a racing heart. Treatments can help reduce anxiety, and differ depending on whether you have generalized anxiety, panic attacks, phobia, or another type of anxiety.

Amyotrophic lateral sclerosis (ALS)

Amyotrophic lateral sclerosis is also called ALS or Lou Gehrig's Disease. It is a degenerative disease that destroys nerve cells, which eventually leads to loss of control over muscle function.

The cause of ALS is not known. It may be inherited and/or due to a chemical imbalance, faulty autoimmune response, or exposure to toxic environmental agents.

Symptoms include weakness; difficulty with speaking, swallowing, walking, or using the hands; and muscle cramps. The muscles of the arms, hands, legs, and feet are most involved at first. It does not affect the senses or a person's mental ability.

ALS is progressive, meaning it worsens over time. There is no cure, but supportive care can keep the patient comfortable and improve quality of life.

Diagnosis is made through several tests including blood tests; urine tests; MRI; electromyography (EMG) to measure muscle activity; nerve conduction studies; and sometimes muscle biopsy or spinal tap (lumbar puncture.)

Treatment involves medications to both slow the progression of the disease and ease the symptoms; respiratory therapy; physical therapy; occupational therapy; and psychological support.

Acid reflux disease (GERD)

Gastroesophageal reflux disease is also called GERD, acid reflux disease, and heartburn. It is caused by a weakening in the muscle at the end of esophagus. This allows stomach acid to flow backward, or reflux, up into the esophagus.

Risks factors for GERD include obesity, smoking, diabetes, hiatal hernia, and pregnancy.

Symptoms include a painful burning sensation in the chest and throat, and sometimes difficulty swallowing.

If heartburn occurs more than twice a week, a doctor should be consulted. If symptoms are accompanied by jaw or arm pain, and/or shortness of breath, these may be signs of a heart attack and constitute a medical emergency.

Repeated exposure to stomach acid damages the lining of the esophagus, causing bleeding, pain, and scar tissue.

Diagnosis is made by patient history and sometimes by x-ray, upper endoscopy, or other tests to measure refluxed acid.

Treatment begins with over-the-counter antacids and lifestyle changes. Medication may be used to reduce stomach acid, and surgery may be done to strengthen the sphincter muscle at the lower end of the esophagus.

Rare and unusual causes

Rare and unusual causes may include the following.

• Vocal cord paralysis: Paralysis of the vocal cords may result from surgical injury, viral infections, or some forms of cancer.
• Laryngeal cancer: Tumors in an around the voice box may make speech difficult or impossible.
• Psychological disorder: The physical structure of the voice box may be normal, but you may experience a psychological block, greater than simple social anxiety, against speaking at all.

3 possible trouble speaking conditions

Questions your doctor may ask about trouble speaking

• How would you describe your speech difficulty?
• Are you having any difficulty walking?
• Did you just suffer from a high impact injury (e.g., a fall, collision, accident or sports trauma)?
• Have you noticed a change in your hearing?