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Diseases » Stroke » Causes
 

Causes of Stroke

Contents
  1. Stroke: Introduction
  2. List of Causes
  3. Drugs/substances (145 causes)
  4. Drug interaction (487 causes)
  5. Hidden causes
  6. Risk factors
  7. Excerpts from book chapters
  8. Complication causes
  9. Causes of symptoms
  10. News
  11. Statistics about causes
  12. Related cause information

List of causes of Stroke

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Stroke) that could possibly cause Stroke includes:

More causes: see full list of causes for Stroke symptoms

Causes of Stroke (Diseases Database):

The follow list shows some of the possible medical causes of Stroke that are listed by the Diseases Database:

Source: Diseases Database

Stroke Causes: Book Excerpts

Stroke as a complication of other conditions:

Other conditions that might have Stroke as a complication may, potentially, be an underlying cause of Stroke. Our database lists the following as having Stroke as a complication of that condition:

Stroke as a symptom:

Conditions listing Stroke as a symptom may also be potential underlying causes of Stroke. Our database lists the following as having Stroke as a symptom of that condition:

Medications or substances causing Stroke:

The following drugs, medications, substances or toxins are some of the possible causes of Stroke as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

See full list of 145 medications causing Stroke


Drug interactions causing Stroke:

When combined, certain drugs, medications, substances or toxins may react causing Stroke as a symptom.

The list below is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

  • TACE and cigarette interaction
  • Premarin and cigarette interaction
  • Cenestin and cigarette interaction
  • Prempro and cigarette interaction
  • Premphase and cigarette interaction
  • more interactions...»

See full list of 487 drug interactions causing Stroke

What causes Stroke?

Article excerpts about the causes of Stroke:

Fact Sheet Heart Disease and Stroke in Women: NWHIC (Excerpt)

A stroke occurs when an artery bringing blood to the brain either becomes clogged or ruptures, and a part of the brain is deprived of the oxygen it needs. Without oxygen, nerve cells in the affected area of the brain are unable to function and then die within minutes. This results in loss of function in the part of the body controlled by these cells. (Source: excerpt from Fact Sheet Heart Disease and Stroke in Women: NWHIC)

HEART AND CARDIOVASCULAR DISEASE: NWHIC (Excerpt)

Lack of blood flow to the brain, from blood clots or broken blood vessels, causes a stroke. In some cases, bleeding in the brain can also cause a stroke. Without a good blood supply, brain cells cannot get enough oxygen and begin to die. (Source: excerpt from HEART AND CARDIOVASCULAR DISEASE: NWHIC)

Stroke Prevention and Treatment - Age Page - Health Information: NIA (Excerpt)

Most strokes are caused by a blood clot or narrowing of a blood vessel (artery) leading to the brain. Other strokes are caused by a hemorrhage (bleeding) from an artery. (Source: excerpt from Stroke Prevention and Treatment - Age Page - Health Information: NIA)

Medical news summaries relating to Stroke:

The following medical news items are relevant to causes of Stroke:

Cause statistics for Stroke:

The following are statistics from various sources about the causes of Stroke:

  • 62% of stroke cases caused caused by high blood pressure worldwide (WHO World Health Report, 2002)
  • Diabetes was the associated cause of death in 8% of stroke deaths in Australia, 2002 (Australia’s Health 2004, AIHW)
  • 22% of deaths from diabetes also had stroke as an associated cause of death in Australia, 2002 (Australia’s Health 2004, AIHW)
  • Cancer was an underlying cause in 1.4% of female deaths from stroke in Australia 1997-2002 (AIHW National Morbidity Database, Australia’s Health 2004, AIHW)
  • Cancer was an underlying cause in 1.4% of male deaths from stroke in Australia 1997-2002 (AIHW National Morbidity Database, Australia’s Health 2004, AIHW)
  • Coronary heart disease was an underlying cause in 3.6% of female deaths from stroke in Australia 1997-2002 (AIHW National Morbidity Database, Australia’s Health 2004, AIHW)
  • Coronary Heart Disease was an underlying cause in 2.6% of male deaths from stroke in Australia 1997-2002 (AIHW National Morbidity Database, Australia’s Health 2004, AIHW)
  • Endocrine disease was an underlying cause in 9.8% of female deaths from stroke in Australia 1997-2002 (AIHW National Morbidity Database, Australia’s Health 2004, AIHW)
  • Endocrine disease was an underlying cause in 6.4% of male deaths from stroke in Australia 1997-2002 (AIHW National Morbidity Database, Australia’s Health 2004, AIHW)
  • Respiratory disease was an underlying cause in 8.9% of female deaths from stroke in Australia 1997-2002 (AIHW National Morbidity Database, Australia’s Health 2004, AIHW)
  • Respiratory disease was an underlying cause in 5.3% of male deaths from stroke in Australia 1997-2002 (AIHW National Morbidity Database, Australia’s Health 2004, AIHW)
  • Stroke was an underlying cause in 63.6% of female deaths from stroke in Australia 1997-2002 (AIHW National Morbidity Database, Australia’s Health 2004, AIHW)
  • Stroke was an underlying cause in 54.1% of male deaths from stroke in Australia 1997-2002 (AIHW National Morbidity Database, Australia’s Health 2004, AIHW)
  • 2.1% of diabetic adults attending specialist diabetes services had a stroke in Australia 2002 (Australia’s Health 2004, AIHW)
  • more statistics...»

Related information on causes of Stroke:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Stroke may be found in:

Causes of Stroke: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Stroke.

Dysarthria: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Neurological causes
    –Lesions of upper motor neurons: Stroke, tumor, abscess, degeneration (e.g., Parkinson's disease); voluntary motor pathways to cranial nerve nuclei 9, 10, and 12 are affected
    –Lesions of lower motor neuron: Brainstem stroke, amyotrophic lateral sclerosis, hypothyroidism, diabetic nerve infarction
    –Lesions of the neuromuscular junction: Myasthenia gravis, prolonged effects of anesthesia, botulism, nerve gas/ organophosphate poisoning; all cause oropharyngeal or glossal weakness
    –Lesions of muscle: Polymyositis, dermatomyositis, inherited muscle diseases such as myotonic muscular dystrophy, mitochondrial diseases
  • Structural causes
    –Tumors of the lips, tongue, squamous cell epithelium of the vocal cords and oropharynx
    –Polyps or salivary gland dysfunction resulting in xerostomia (dry mouth)
    –Hypoglossal nerve damage due to surgical traction from carotid endarterectomy
  • Less common etiologies include glossitis (amyloidosis, hypothyroidism, anaerobic infection), acute dystonic reaction, unrecognized foreign accent, mild cerebral palsy, sedative/anticonvulsant intoxication, poor dentition or ill-fitting dentures, cleft palate

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Flank Pain/CVA Tenderness: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Degenerative disk disease and/or disk herniation is the most frequent cause of pain
  • Muscle spasm or cramping
  • Trauma
  • Nephrolithiasis/urolithiasis (renal or ureteral calculi or stones) is the most common urinary tract etiology
  • Pyelonephritis (acute or chronic)
    –E. coli is the most common cause of upper and lower urinary infections, followed by Staphylococcus saprophyticus
    –Acute pyelonephritis is usually a complication of a lower UTI
    –Chronic pyelonephritis is usually associated with obstruction
    • Perirenal (kidney) abscess
    • Acute pancreatitis
    • Glomerulonephritis
    • Herpes zoster
    • Bacterial cystitis
    • Polycystic kidney disease
    • Renal infarction or trauma
    • Papillary necrosis
    • Duodenal ulcer
    • Cholecystitis or biliary colic
    • Pneumonia
    • Appendicitis
    • Obstructive uropathy
    • Ectopic pregnancy
    • Cervicitis
    • Renal or bladder cancer
    • Leaking or ruptured abdominal aortic aneurysm

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Dysarthria: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Alcoholic cerebellar degeneration

Alcoholic cerebellar degeneration commonly causes chronic, progressive dysarthria along with ataxia, diplopia, ophthalmoplegia, hypotension, and an altered mental status.

Amyotrophic lateral sclerosis (ALS)

Dysarthria occurs when ALS affects the bulbar nuclei; it may worsen as the disease progresses. Other signs and symptoms include dysphagia; difficulty breathing; muscle atrophy and weakness, especially of the hands and feet; fasciculations; spasticity; hyperactive DTRs in the legs; and, occasionally, excessive drooling. Progressive bulbar palsy may cause crying spells or inappropriate laughter.

Basilar artery insufficiency.

Basilar artery insufficiency causes random, brief episodes of bilateral brain stem dysfunction, resulting in dysarthria. Accompanying it are diplopia, vertigo, facial numbness, ataxia, paresis, and visual field loss, all of which last for minutes to hours.

Botulism.

The hallmark of botulism is acute cranial nerve dysfunction causing dysarthria, dysphagia, diplopia, and ptosis. Early findings include a dry mouth, a sore throat, weakness, vomiting, and diarrhea. Later, descending weakness or paralysis of muscles in the extremities and trunk causes hyporeflexia and dyspnea.

Mercury poisoning

Chronic mercury poisoning causes progressive dysarthria accompanied by weakness, fatigue, depression, lethargy, irritability, confusion, ataxia, and tremors.

Multiple sclerosis

When demyelination affects the brain stem and cerebellum, the patient displays dysarthria accompanied by nystagmus, blurred or double vision, dysphagia, ataxia, and intention tremor. Exacerbations and remissions of these signs and symptoms are common. Other findings include paresthesia, spasticity, intention tremor, hyperreflexia, muscle weakness or paralysis, constipation, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis

Myasthenia gravis is a neuromuscular disorder that causes dysarthria associated with a nasal voice tone. Typically, the dysarthria worsens during the day and may temporarily improve with short rest periods. Other findings include dysphagia, drooling, facial weakness, diplopia, ptosis, dyspnea, and muscle weakness.

Olivopontocerebellar degeneration

Dysarthria, a major sign, accompanies cerebellar ataxia and spasticity.

Parkinson's disease

Parkinson's disease produces dysarthria and a monotone voice. It also produces muscle rigidity, bradykinesia, involuntary tremor usually beginning in the fingers, difficulty walking, muscle weakness, and a stooped posture. Other findings include masklike facies, dysphagia, and occasionally drooling.

Shy-Drager syndrome

Marked by chronic orthostatic hypotension, Shy-Drager syndrome eventually causes dysarthria as well as cerebellar ataxia, bradykinesia, masklike facies, dementia, impotence and, possibly, a stooped posture and incontinence.

Stroke (brain stem).

A brain stem stroke is characterized by bulbar palsy, resulting in the triad of dysarthria, dysphonia, and dysphagia. Dysarthria is most severe at its onset; it may lessen or disappear with rehabilitation and training. Other findings include facial weakness, diplopia, hemiparesis, spasticity, drooling, dyspnea, and a decreased LOC.

Stroke (cerebral).

A massive bilateral stroke causes pseudobulbar palsy. Bilateral weakness produces dysarthria that's most severe at onset. This sign is accompanied by dysphagia, drooling, dysphonia, bilateral hemianopsia, and aphasia. Sensory loss, spasticity, and hyperreflexia may also occur.

Other causes

Drugs

Dysarthria can occur when the anticonvulsant dosage is too high. Ingestion of large doses of barbiturates may also cause dysarthria.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Dysarthria: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Alcoholic cerebellar degeneration

This disorder commonly causes chronic, progressive dysarthria along with ataxia, diplopia, ophthalmoplegia, hypotension, and altered mental status.

Amyotrophic lateral sclerosis

Dysarthria occurs when this disorder affects the bulbar nuclei; it may worsen as the disease progresses. Other signs and symptoms include dysphagia; difficulty breathing; muscle atrophy and weakness, especially of the hands and feet; fasciculations; spasticity; hyperactive DTRs in the legs; and occasionally excessive drooling. Progressive bulbar palsy may cause crying spells or inappropriate laughter.

Basilar artery insufficiency

This disorder causes random, brief episodes of bilateral brain stem dysfunction, resulting in dysarthria. Accompanying it are diplopia, vertigo, facial numbness, ataxia, paresis, and visual field loss, all of which can last from minutes to hours.

Botulism

The hallmark of this disorder is acute cranial nerve dysfunction that causes dysarthria, dysphagia, diplopia, and ptosis. Early findings include dry mouth, sore throat, weakness, vomiting, and diarrhea. Later, descending weakness or paralysis of muscles in the extremities and trunk causes hyporeflexia and dyspnea.

Multiple sclerosis

When demyelination affects the brain stem and cerebellum, the patient displays dysarthria accompanied by nystagmus, blurred or double vision, dysphagia, ataxia, and intention tremor. Exacerbations and remissions of these signs and symptoms are common. Other findings include paresthesia, spasticity, intention tremor, hyperreflexia, muscle weakness or paralysis, constipation, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis

This neuromuscular disorder causes dysarthria associated with a nasal voice tone. Typically, the dysarthria worsens during the day and may temporarily improve with short rest periods. Other findings include dysphagia, drooling, facial weakness, diplopia, ptosis, dyspnea, and muscle weakness.

Olivopontocerebellar degeneration

Dysarthria, a cardinal sign of this disorder, accompanies cerebellar ataxia and spasticity.

Parkinson’s disease

This disorder produces dysarthria and a monotone voice. It also produces muscle rigidity, bradykinesia, an involuntary tremor that usually begins in the fingers, difficulty walking, muscle weakness, and stooped posture. Other findings include masklike facies, dysphagia and, occasionally, drooling.

Shy-Drager syndrome

Marked by chronic orthostatic hypotension, this syndrome eventually causes dysarthria as well as cerebellar ataxia, bradykinesia, masklike facies, dementia, impotence and, possibly, stooped posture and incontinence.

Stroke (brain stem)

This type of stroke is characterized by bulbar palsy, resulting in the triad of dysarthria, dysphonia, and dysphagia. The dysarthria is most severe at the onset of the stroke; it may lessen or disappear with rehabilitation and training. Other findings include facial weakness, diplopia, hemiparesis, spasticity, drooling, dyspnea, and decreased LOC.

Stroke (cerebral)

A massive bilateral stroke causes pseudobulbar palsy. Bilateral weakness produces dysarthria that’s most severe at the stroke’s onset. This sign is accompanied by dysphagia, drooling, dysphonia, bilateral hemianopsia, and aphasia. Sensory loss, spasticity, and hyperreflexia may also occur.

Other causes

Drugs

Dysarthria can occur when anticonvulsant dosage is too high. Ingestion of large doses of barbiturates may also cause dysarthria.

Manganese poisoning

Chronic manganese poisoning causes progressive dysarthria accompanied by weakness, fatigue, confusion, hallucinations, drooling, hand tremors, limb stiffness, spasticity, gross rhythmic movements of the trunk and head, and a propulsive gait.

Mercury poisoning

Chronic mercury poisoning causes progressive dysarthria accompanied by weakness, fatigue, depression, lethargy, irritability, confusion, ataxia, and tremors.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Stroke Syndromes: Differential Overview

(Field Guide to Bedside Diagnosis)

TIA/Stroke

❑ Middle cerebral artery stroke

❑ Anterior cerebral artery stroke

❑ Posterior cerebral artery stroke

❑ Watershed stroke

❑ Thalamic lacune

❑ Vertebrobasilar ischemia

❑ Pontine lacune

❑ Pontine stroke

❑ Midbrain stroke

❑ Pure motor hemiplegia

❑ Ataxic hemiparesis

❑ Lateral medullary stroke

❑ Temporal lobe stroke

Hemorrhage

❑ Subarachnoid hemorrhage

❑ Cerebellar hemorrhage

❑ Thalamic hemorrhage

❑ Pontine hemorrhage

❑ Putaminal hemorrhage

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Aphasia/Dysarthria: Differential Overview
(Field Guide to Bedside Diagnosis)

Aphasia (Central)

❑ Broca

❑ Wernicke

❑ Conduction

❑ Anomic

❑ Global

❑ Motor aphasia

❑ Pure word deafness

❑ Alexia without agraphia

❑ Alexia with agraphia

Dysarthria (Peripheral)

❑ Bulbar

❑ Parkinson

❑ Multiple sclerosis

❑ Tongue infiltration

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Stroke: Causes
(Handbook of Diseases)

Factors that increase the risk of stroke include history of transient ischemic attacks (TIAs), atherosclerosis, hypertension, electrocardiogram changes, arrhythmias, rheumatic heart disease, diabetes mellitus, gout, postural hypotension, cardiac or myocardial enlargement, high serum triglyceride levels, lack of exercise, use of hormonal contraceptives, cigarette smoking, and family history of stroke.

The major causes of stroke are thrombosis, embolism, and hemorrhage.

Thrombosis

In middle-aged and elderly people — among whom there’s a higher incidence of atherosclerosis, diabetes, and hypertension — thrombosis is the most common cause of stroke. Obstruction of a blood vessel causes the stroke. Typically, the main site of the obstruction is the extracerebral vessels, but sometimes it’s the intracerebral vessels.

Thrombosis causes ischemia in brain tissue supplied by the affected vessel as well as congestion and edema. The latter may produce more symptoms than the thrombosis itself, but these subside with the edema.

Thrombosis may develop while the patient sleeps or shortly after he awakens; it can also occur during surgery or after a myocardial infarction. The risk increases with obesity, smoking, or the use of hormonal contraceptives. Cocaine-induced ischemic stroke is now seen in younger patients.

Embolism

The second most common cause of stroke, embolism is an occlusion of a blood vessel caused by a fragmented clot, a tumor, fat, bacteria, or air. It can occur at any age, especially among patients with a history of rheumatic heart disease, endocarditis, posttraumatic valvular disease, or myocardial fibrillation and other cardiac arrhythmias or after open-heart surgery or placement of a mechanical heart valve.

The embolus usually develops rapidly — in 10 to 20 seconds — and without warning. When it reaches the cerebral vasculature, it cuts off circulation by lodging in a narrow portion of an artery, most commonly the middle cerebral artery, causing necrosis and edema.

If the embolus is septic and infection extends beyond the vessel wall, an abscess or encephalitis may develop. If the infection is within the vessel wall, an aneurysm may form, which could lead to cerebral hemorrhage.

Hemorrhage

The third most common cause of stroke is hemorrhage. Like an embolism, it may occur suddenly, at any age. Such hemorrhage results from chronic hypertension or aneurysms, which cause sudden rupture of a cerebral artery. The rupture diminishes blood supply to the area served by this artery. In addition, blood accumulates deep within the brain, further compressing neural tissue and causing even greater damage.

Stroke classification

Strokes are classified according to their course of progression. The least severe is the TIA, or little stroke, which results from a temporary interruption of blood flow, usually in the carotid and vertebrobasilar arteries. A progressive stroke, or stroke-in-evolution (thrombus-in-evolution), begins with slight neurologic deficit and worsens in a day or two. In a completed stroke, neurologic deficits are maximal at onset and don’t progress.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Dysarthria: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

See Dysarthria: Causes and associated findings, pages 114 and 115.

Alcoholic cerebellar degeneration

Alcoholic cerebellar degeneration commonly causes chronic, progressive dysarthria along with ataxia, diplopia, ophthalmoplegia, hypotension, and altered mental status.

Amyotrophic lateral sclerosis (ALS)

Dysarthria occurs when ALS affects the bulbar nuclei; it may worsen as the disease progresses. Other signs and symptoms include dysphagia; difficulty breathing; muscle atrophy and weakness, especially of the hands and feet; fasciculations; spasticity; hyperactive DTRs in the legs; and occasionally excessive drooling. Progressive bulbar palsy may cause crying spells or inappropriate laughter.

Basilar artery insufficiency.

Basilar arteryinsufficiency causes random, brief episodes of bilateral brain stem dysfunction, resulting in dysarthria. Accompanying it are diplopia, vertigo, facial numbness, ataxia, paresis, and visual field loss, all of which last for minutes to hours.

Botulism

The hallmark of botulism is acute cranial nerve dysfunction causing dysarthria, dysphagia, diplopia, and ptosis. Early findings include dry mouth, sore throat, weakness, vomiting, and diarrhea. Later, descending weakness or paralysis of muscles in the extremities and trunk causes hyporeflexia and dyspnea.

Manganese poisoning

Chronic manganese poisoning causes progressive dysarthria accompanied by weakness, fatigue, confusion, hallucinations, drooling, hand tremors, limb stiffness, spasticity, gross rhythmic movements of the trunk and head, and propulsive gait.

Mercury poisoning

Chronic mercury poisoning also causes progressive dysarthria accompanied by weakness, fatigue, depression, lethargy, irritability, confusion, ataxia, and tremors.

Multiple sclerosis

When demyelination affects the brain stem and cerebellum, the patient displays dysarthria accompanied by nystagmus, blurred or double vision, dysphagia, ataxia, and intention tremor. Exacerbations and remissions of these signs and symptoms are common. Other findings include paresthesia, spasticity, intention tremor, hyperreflexia, muscle weakness or paralysis, constipation, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis.

Myasthenia gravis is a neuromuscular disorder that causes dysarthria associated with a nasal voice tone. Typically, the dysarthria worsens during the day and may temporarily improve with short rest periods. Other findings include dysphagia, drooling, facial weakness, diplopia, ptosis, dyspnea, and muscle weakness.

Olivopontocerebellar degeneration

Dysarthria, a major sign, accompanies cerebellar ataxia and spasticity.

Parkinson’s disease

Parkinson’s disease produces dysarthria and a monotone voice. It also produces muscle rigidity, bradykinesia, involuntary tremor usually beginning in the fingers, difficulty in walking, muscle weakness, and stooped posture. Other findings include masklike facies, dysphagia, and occasionally drooling.

Shy-Drager syndrome

Marked by chronic orthostatic hypotension, Shy-Drager syndrome eventually causes dysarthria as well as cerebellar ataxia, bradykinesia, masklike facies, dementia, impotence and, possibly, stooped posture and incontinence.

Stroke (brain stem)

Brain stem stroke is characterized by bulbar palsy, resulting in the triad of dysarthria, dysphonia, and dysphagia. The dysarthria is most severe at onset; it may lessen or disappear with rehabilitation and training. Other findings include facial weakness, diplopia, hemiparesis, spasticity, drooling, dyspnea, and decreased LOC.

Stroke (cerebral)

A massive bilateral stroke causes pseudobulbar palsy. Bilateral weakness produces dysarthria that’s most severe at onset. This sign is accompanied by dysphagia, drooling, dysphonia, bilateral hemianopsia, and aphasia. Sensory loss, spasticity, and hyperreflexia may also occur.

Other causes

Drugs

Dysarthria can occur when anticonvulsant dosage is too high. Ingestion of large doses of barbiturates may also cause dysarthria.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Dysarthria: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Alcoholic cerebellar degeneration

Alcoholic cerebellar degeneration commonly causes chronic, progressive dysarthria along with ataxia, diplopia, ophthalmoplegia, hypotension, and altered mental status.

Amyotrophic lateral sclerosis

Dysarthria occurs when amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig disease, affects the bulbar nuclei; it may worsen as the disease progresses. Other signs and symptoms of ALS include dysphagia; difficulty breathing; muscle atrophy and weakness, especially of the hands and feet; fasciculations; spasticity; hyperactive DTRs in the legs; and occasionally excessive drooling. Progressive bulbar palsy may cause crying spells or inappropriate laughter.

Basilar artery insufficiency

Basilar artery insufficiency causes random, brief episodes of bilateral brain stem dysfunction, resulting in dysarthria. Accompanying it are diplopia, vertigo, facial numbness, ataxia, paresis, and visual field loss, all of which last for minutes to hours.

Botulism

The hallmark of botulism is acute cranial nerve dysfunction causing dysarthria, dysphagia, diplopia, and ptosis. Early findings include dry mouth, sore throat, weakness, vomiting, and diarrhea. Later, descending weakness or paralysis of muscles in the extremities and trunk causes hyporeflexia and dyspnea.

Manganese poisoning

Chronic manganese poisoning causes progressive dysarthria accompanied by weakness, fatigue, confusion, hallucinations, drooling, hand tremors, limb stiffness, spasticity, gross rhythmic movements of the trunk and head, and propulsive gait.

Mercury poisoning

Chronic mercury poisoning also causes progressive dysarthria accompanied by weakness, fatigue, depression, lethargy, irritability, confusion, ataxia, and tremors. Changes in vision, hearing, and memory may also occur.

Multiple sclerosis

When demyelination affects the brain stem and cerebellum, the patient displays dysarthria accompanied by nystagmus, blurred or double vision, dysphagia, ataxia, and intention tremor. Exacerbations and remissions of these signs and symptoms are common. Other findings of multiple sclerosis include paresthesia, spasticity, intention tremor, hyperreflexia, muscle weakness or paralysis, constipation, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis

Myasthenia gravis is a neuromuscular disorder that causes dysarthria associated with a nasal voice tone. Typically, the dysarthria worsens during the day and may temporarily improve with short rest periods. Other findings include dysphagia, drooling, facial weakness, diplopia, ptosis, dyspnea, and muscle weakness.

Olivopontocerebellar degeneration

Dysarthria, a major sign of olivopontocerebellar degeneration, accompanies cerebellar ataxia and spasticity. The patient may also have abnormal eye movement, sexual dysfunction, bowel and bladder problems, and difficulty swallowing.

Parkinson’s disease

Parkinson’s disease produces dysarthria and a monotone voice. It also produces muscle rigidity, bradykinesia, involuntary tremor usually beginning in the fingers, difficulty in walking, muscle weakness, and stooped posture. Other findings include masklike facies, dysphagia, and occasionally drooling.

Stroke (brain stem)

Brain stem stroke is characterized by bulbar palsy, resulting in the triad of dysarthria, dysphonia, and dysphagia. The dysarthria is most severe at onset; it may lessen or disappear with rehabilitation and training. Other findings include facial weakness, diplopia, hemiparesis, spasticity, drooling, dyspnea, and decreased LOC.

Stroke (cerebral)

A massive bilateral cerebral stroke causes pseudobulbar palsy. Bilateral weakness produces dysarthria that’s most severe at onset. This sign is accompanied by dysphagia, drooling, dysphonia, bilateral hemianopsia, and aphasia. Sensory loss, spasticity, and hyperreflexia may also occur.

Other causes

Drugs

Dysarthria can occur when anticonvulsant dosage is too high. Ingestion of large doses of barbiturates may also cause dysarthria.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Dysarthria: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Alcoholic cerebellar degeneration.Alcoholic cerebellar degeneration commonly causes chronic, progressive dysarthria along with ataxia, diplopia, ophthalmoplegia, hypotension, and an altered mental status.

Amyotrophic lateral sclerosis (ALS).Dysarthria occurs when ALS affects the bulbar nuclei; it may worsen as the disease progresses. Other signs and symptoms include dysphagia; difficulty breathing; muscle atrophy and weakness, especially of the hands and feet; fasciculations; spasticity; hyperactive DTRs in the legs; and, occasionally, excessive drooling. Progressive bulbar palsy may cause crying spells or inappropriate laughter.

Basilar artery insufficiency.Basilar artery insufficiency causes random, brief episodes of bilateral brain stem dysfunction, resulting in dysarthria. Accompanying it are diplopia, vertigo, facial numbness, ataxia, paresis, and visual field loss, all of which last for minutes to hours.

Botulism.The hallmark of botulism is acute cranial nerve dysfunction causing dysarthria, dysphagia, diplopia, and ptosis. Early findings include a dry mouth, a sore throat, weakness, vomiting, and diarrhea. Later, descending weakness or paralysis of muscles in the extremities and trunk causes hyporeflexia and dyspnea.

Mercury poisoning.Chronic mercury poisoning causes progressive dysarthria accompanied by weakness, fatigue, depression, lethargy, irritability, confusion, ataxia, and tremors.

Multiple sclerosis (MS).When demyelination affects the brain stem and cerebellum as with MS, the patient displays dysarthria accompanied by nystagmus, blurred or double vision, dysphagia, ataxia, and intention tremor. Exacerbations and remissions of these signs and symptoms are common. Other findings include paresthesia, spasticity, intention tremor, hyperreflexia, muscle weakness or paralysis, constipation, emotional lability, and urinary frequency, urgency, and incontinence.

Myasthenia gravis.Myasthenia gravis causes dysarthria associated with a nasal voice tone. Typically, the dysarthria worsens during the day and may temporarily improve with short rest periods. Other findings include dysphagia, drooling, facial weakness, diplopia, ptosis, dyspnea, and muscle weakness.

Olivopontocerebellar degeneration.Dysarthria, a major sign of olivopontocerebellar degeneration, accompanies cerebellar ataxia and spasticity.

Parkinson's disease.Parkinson's disease produces dysarthria and a monotone voice. It also produces muscle rigidity, bradykinesia, involuntary tremor usually beginning in the fingers, difficulty walking, muscle weakness, and a stooped posture. Other findings include masklike facies, dysphagia, and occasionally drooling.

Shy-Drager syndrome.Marked by chronic orthostatic hypotension, Shy-Drager syndrome eventually causes dysarthria as well as cerebellar ataxia, bradykinesia, masklike facies, dementia, impotence and, possibly, a stooped posture and incontinence.

Stroke (brain stem).A brain stem stroke is characterized by bulbar palsy, resulting in the triad of dysarthria, dysphonia, and dysphagia. Dysarthria is most severe at its onset; it may lessen or disappear with rehabilitation and training. Other findings include facial weakness, diplopia, hemiparesis, spasticity, drooling, dyspnea, and a decreased LOC.

Stroke (cerebral).A massive bilateral stroke causes pseudobulbar palsy. Bilateral weakness produces dysarthria that's most severe at onset. This sign is accompanied by dysphagia, drooling, dysphonia, bilateral hemianopsia, and aphasia. Sensory loss, spasticity, and hyperreflexia may also occur.

Other causes

Drugs.Dysarthria can occur when the anticonvulsant dosage is too high. Ingestion of large doses of barbiturates may also cause dysarthria.

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Source: Nursing: Interpreting Signs and Symptoms, 2007


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