Is the patient's speech hoarse, slurred, quiet, breathy, nasal, low or high pitched, and so on? It is often important to ask if the patient's speech has changed from baseline. Note that dysarthria (see Neuroanatomy through Clinical Cases, Key Clinical Concept 12.8), or abnormal pronunciation of speech, is not the same as aphasia, which is an abnormality in language production or comprehension.
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Abnormal articulation of speech can occur in lesions involving the muscles of articulation, the neuromuscular junction, or the peripheral or central portions of CN V, VII, IX, X, or XII. Furthermore, speech production can be abnormal as a result of lesions in the motor cortex, cerebellum, basal ganglia, or descending pathways to the brainstem.