Amyotrophic Lateral Sclerosis (ALS): This condition is characterized by progressive muscle weakness, atrophy, and fasciculations, along with hyperreflexia (hyperactivity of deep tendon reflexes, DTRs) due to upper motor neuron involvement. Grip weakness and dysarthria (speech difficulties) are common symptoms, making ALS a strong candidate for this combination of symptoms.

Multiple Sclerosis (MS): MS can present with a wide range of neurological symptoms, including weakness, spasticity (leading to hyperactive DTRs), and speech difficulties. While the pattern of symptoms can vary, MS is a consideration in patients with these complaints.
Stroke or Transient Ischemic Attack (TIA): Acute vascular events in the brain can lead to sudden onset of weakness, dysarthria, and changes in reflexes, depending on the area of the brain affected. The pattern of hyperactive DTRs might be less common but can occur, especially if there is involvement of the corticospinal tract.
Spinal Cord Injury or Compression: Trauma, herniated discs, or other forms of spinal cord compression can lead to upper motor neuron signs (such as hyperactive DTRs) below the level of the lesion, along with weakness and potentially dysarthria if the injury is high enough in the cervical spine.

Subarachnoid Hemorrhage: Although less common, a subarachnoid hemorrhage can present with sudden onset of severe headache, possible weakness, and changes in mental status, including dysarthria. The initial presentation might not always include clear signs of hyperactive DTRs, but given the potentially catastrophic outcome, it's crucial not to miss this diagnosis.
Meningitis or Encephalitis: Infections of the meninges or brain can lead to a variety of neurological symptoms, including weakness, changes in reflexes, and speech difficulties. These conditions require urgent diagnosis and treatment.

Kennedy's Disease (Spinal and Bulbar Muscular Atrophy): A rare X-linked recessive disorder that affects males, characterized by progressive muscle weakness, atrophy, and fasciculations, along with bulbar symptoms like dysarthria. Hyperactive DTRs can be present due to the involvement of the spinal cord.
Creutzfeldt-Jakob Disease: A rare, degenerative, fatal brain disorder that can present with a variety of neurological symptoms, including dysarthria, weakness, and changes in reflexes. The disease progresses rapidly, making early diagnosis challenging.
Tetanus: Although rare in areas with good vaccination coverage, tetanus infection can cause muscle stiffness, spasms, and hyperreflexia, along with dysarthria due to muscle rigidity affecting the muscles of speech.