Stroke

Key Glossary Terms

Neurological Voice Disorders
Voice problems caused by abnormal control, coordination, or strength of voice box muscles due to an underlying neurological disease such as: stroke, Parkinson's disease, multiple sclerosis, myasthenia gravis, or ALS

Dysarthria
Difficulty forming words – presenting with imprecise consonants and hard-to-understand speech as seen with stroke patients

Speech Disorder
Malfunction of the tongue and/or lip muscles resulting in garbled words or parts or words.

Glossary

Stroke results from interrupted blood flow to the brain or brainstem and is generally seen in males above the age of 50. The risk factors for stroke include high blood pressure, high cholesterol levels, and vascular disease.

• Vocal symptoms typically consist of a hoarse, breathy voice when the brainstem is involved in stroke; these symptoms are due to paralysis of the vocal fold muscles on one side.
• Often, the patient will also experience swallowing difficulties as well as coughing/choking (especially when drinking liquids); these symptoms can be quite severe and debilitating.
• The combination of a paralyzed vocal fold, poor airway protection, weakened swallowing muscles, and loss of feeling/sensation in the throat probably explains the severe nature of swallowing problems in some stroke patients.
• Occasionally, a weak palate will cause a hypernasal voice.

• Vocal symptoms with cerebral cortex strokes are more often related to articulation disorders (slurred speech, or dysarthria) rather than hoarseness.
• Some patients may have loss of speaking ability (aphasia) when the dominant brain hemisphere is affected.

Red Flag

Voice/speech disturbances are not initially the dominant symptoms in stroke. Dominant symptoms can include weakness or paralysis of the arms and/or legs, incoordination (ataxia), numbness in the arms/legs, partial/total loss of vision, and loss of consciousness/coma.

Generally, a specialist in nerve/brain disorders (neurologist) is the most appropriate physician for the diagnosis and treatment of stroke. An MRI or CAT scan is generally ordered to locate the area of the brain affected, but a good history and physical examination often pinpoints the diagnosis.

• New clot-dissolving drugs, when administered early during the emergence of stroke symptoms, can make a huge difference in minimizing the dysfunction caused by stroke.
• The overall prognosis of stroke varies considerably; in general older patients face a worse prognosis for recovery of function. Vocal and swallowing difficulties often persist and can be so severe that the patient is dependent on a feeding tube for nutrition and is unable to communicate.
• Speech and swallowing therapy with a speech/language pathologist is essential in the rehabilitation process for many stroke patients. These services can significantly improve the stroke patient's ability to communicate, swallow, and cope.