How a Stroke Can Affect the Tongue

A droopy face is among the signs of stroke, according to Harvard Health Publishing, but did you know can also impact the tongue, causing numbness or crookedness?

In a Gallup poll, 97 percent of people older than 50 could not readily recognize the indicators of a stroke, says Harvard Health. That's troubling because the degree to which a stroke can inflict significant and long-lasting damage is often a direct function of how quickly a stroke victim gets the care he or she needs.

"More common symptoms of stroke include slurred speech, paralysis or weakness of one side of the body," says Gregg Fonarow, MD, director of the Ahmanson-University of California Los Angeles Cardiomyopathy Center. But, he adds, "sudden numbness of the tip or side of the tongue can be seen in a certain type of stroke" and can include "the tongue deviating or being crooked."

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Recognizing stroke symptoms, whether common or not, is important. According to a 2019 AHA fact sheet, strokes accounted for roughly one of every 19 deaths in 2016. That means that on its own — distinct from other forms of heart disease — strokes rank as the fifth leading cause of death in the US. That translates to roughly 142,000 stroke-induced fatalities every year.

At least a quarter of all stroke victims end up experiencing some type of language-related impairment, according to the National Institute on Deafness and Other Communication Disorders (NIDCD). This can take the form of an inability to write, to read or to understand speech.

It can also result in having difficulty speaking. In fact, the sudden onset of a speech impediment — due to a stroke-triggered condition known as dysarthria — is one of the telltale signs of a stroke, according to the American Heart Association (AHA).

Characterized by slurred or slow speech, dysarthria results when the tongue muscles required for speaking either weaken or become hard to control, an impairment that can arise as a result of a wide array of nervous system disorders, stroke among them, notes the Mayo Clinic.

Signs of dysarthria may also include being unable to speak louder than a whisper or speaking unusually loudly, as well as very rapid speech, a nasal or raspy voice, an uneven speech pattern or monotonal speech, says Mayo Clinic. The person also may have trouble moving the tongue or face muscles.

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Another possible stroke-provoked symptom, according to the AHA, is dysphagia, which makes swallowing extremely difficult.

The NIDCD points out that dysphagia is essentially a neural control problem that weakens both the tongue and cheek muscles. Swallowing, chewing and moving food through the mouth can become difficult because of stroke-caused damage to the part of the brain that controls the muscles needed for these things. In fact, when dysphagia strikes, swallowing can become extremely difficult and, in some cases, completely impossible.

Another classic warning sign that a stroke may have occurred is an unusual tongue position, known as tongue deviation.

"When the motor cortex in the brain is damaged, the hypoglossal nerve — which is a pure motor nerve innervating the muscles of the tongue — will be defective," Dr. Fonarow explains. "Therefore, the tongue will have a tendency to turn away from the midline when extended or protruded, and it will deviate toward the side of the [brain] lesion."

"This is called tongue deviation," he says, adding that the onset of tongue deviation has long been understood to be a telltale symptom of a stroke.

"The symptom of tongue deviation in stroke patients has been observed from ancient to modern times," he says. In fact, "for thousands of years, the deviation of the tongue has also been recognized as a symptom of what is called a 'wind stroke' in traditional Chinese medicine."

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