Question:

My mother in law suffered a mini-stroke approximately 1 year ago. My husband and I immediately noticed her “slurred” speech and urged her to go to the doctor. She was not immediately diagnosed correctly, so any kind of treatment was not started.

Here is where I’m confused: we could understand her speech, but it has gradually got worse and worse, along with her not being able to swallow, she no longer speaks, and her tongue (back of it) is basically paralyzed. She lost 55 pounds and is now getting ready for a feeding tube.

I thought that once a stroke hit, the damage was done – I didn’t think symptoms would deteriorate to this point? Am I wrong? Please help!! Thanks!

Answer:

First of all I commend you and your husband for being such wonderful advocates for your mother-in-law. When one person has a stroke it affects the entire family and it is great to see that you are providing such great support for her during the medical challenges she is going through. 

I am a medical speech-language pathologist not a physician. For this reason it would be best for you to check with your mother-in-law’s medical doctor regarding the details and the pattern of her medical condition.

However, I would like to make a few comments that I hope are helpful for you. 

From the description you provided in your question – long lasting paralysis of the tongue resulting in serious swallowing difficulties- it sounds as though your mother-in-law had a major stroke rather than a transient ischemic attack (also referred to as a TIA or mini stroke).

If in fact she suffered major impairments in muscle function in the mouth area after the episode that she had, then it would be expected that paralysis of the tongue that you describe would result in speech and swallowing difficulties…the severity of which would depend on the amount of damage she experienced as a result of the medical situation. 

On the other hand, you also said in your question that your mother-in-law’s speech “got worse.”

Generally after a stroke is complete, the damage that the stroke has caused is also finished. The person is left with resulting impairments that may remain or may improve over time.

It would be logical that her overall medical situation might deteriorate over time if she is not able to eat as a result of the stroke. If she is trying to eat using her mouth but is receiving a reduced caloric intake as a result of the serious swallowing difficulty (which is why they probably want to tube feed her–so that she can get adequate nutrition and hydration –and so that she does not continue to lose weight)
 
However the swallowing difficulty and the speech difficulty should not continue to get worse, unless perhaps they are declining as a result of her losing energy and becoming extremely fatigued due to the reduced food intake and resulting poor nutrition.

People with “slurred speech” and swallowing difficulties will continue to deteriorate as fatigue increases. Could this be what you are noticing?

If not, and if you think your mother-in-law is demonstrating a progressive deterioration with drastically worsening difficulties of speech and swallowing then you should ask her doctor to explain to you the testing that was done to rule out a “progressive disorder”.

I am sure the medical doctor has done the necessary tests to rule out any medical condition beyond the stroke…but it will be reassuring for you and your husband (and your mother-in-law!) to have the doctor explain how he/she decided that the medial consequences that you see with the speech and swallowing are due to the stroke alone and not any additional medical conditions. 

I hope that these thoughts are helpful to you, and I hope they help you to formulate questions to ask your mother-in-law’s doctor.

Once you ask the right questions and the doctor explains their logic to you I think things will become a little clearer. 

I wish you, your husband and mother-in-law the very best.

If you have any additional questions or would like any issues clarified please feel free to post another question to me. If you would like to keep me updated on your mother’s situation please do.

Take care.

For more information:

Go to the Stroke health topic.