Motor difficulty in speech with impaired articulation and pronunciation has been termed dysarthria. Although the list of neurological causes of dysarthria is long, an elderly patient with acute dysarthria associated with myocardial infarction would often be presumed to have had a stroke. We were asked to evaluate a patient with stroke who had an unexpected mechanical cause for dysarthria.
A 67-year-old woman with diabetes awoke with jaw pain, right arm pain and numbness, and difficulty speaking and swallowing. She wrote a barely legible note saying "take me to the hospital." Five days earlier she had a brief episode of headache and right arm numbness associated with difficulty finding the right word and speaking intelligibly.
Electrocardiogram showed acute myocardial infarction and she was treated with tissue-type plasminogen activator. The pain in the right arm and in the jaw, as well as the right arm numbness, resolved, but her speech and swallowing