Stroke Symptoms Less Common

Most common symptoms of stroke are the result of anterior strokes (strokes in the front of the brain). Posterior strokes (those that occur in the basilar territory) are more likely to affect the brain stem, the cerebellum, and the thalamus (an area in the center of the brain that acts as a “switchboard” for most brain activity). Symptoms of a stroke in the posterior region of the brain can include difficulty swallowing (dysphasia), paralysis, or even sudden death.

Unusual symptoms of stroke may also result from “lacunar” strokes. A lacunar stroke affects smaller, localized areas of the brain, and is often caused by blood flow obstruction in smaller arteries. Symptoms of lacunar strokes are usually less severe than anterior or posterior strokes.

Unusual Symptoms of Posterior Stroke: Ataxia, Nystagmus, and Sudden Death

Ataxia: Ataxia is a loss of muscle coordination. Voluntary movements are disjointed or jerky. Ataxia can affect any area of the body, and is one of the symptoms associated with cerebellar stroke. Ataxia can affect vision and speech, depending on which muscles are involved. Ataxia may also cause dysphagia (difficulty swallowing).

Dysarthria: Dysarthria refers to a speech difficulty. Rather than affecting the brain’s language centers, dysarthria causes muscular weakness in the tongue muscles. Symptoms of dysarthria include slow, slurred speech. People suffering from dysarthria may benefit from speech therapy.

Dysphagia: Dysphagia refers to a difficulty in swallowing. A difficulty in swallowing may occur if the swallowing reflex is impaired, however dysphagia may also result from impaired muscular coordination of the tongue or throat muscles. A number of stroke events may result in dysphagia.Dysphagia creates a number of complications. Difficulty swallowing increases the chances of choking, or, getting food particles in the lungs (known as aspiration pneumonia). Malnutrition may also result from difficulty swallowing, as eating is difficult (and in some cases impossible), time-consuming, and upsetting.

Hemiballism: Hemiballism is a condition associated with stroke, where muscles on one side of the body experience involuntary and uncontrollable twitching. This movement is often sudden and violent in nature and is the result of injury to the opposite side of the brain.

Voice hoarseness: A hoarse voice may result from muscle paralysis or other effects of stroke that affect the vocal cords.

Nystagmus: Nystagmus describes uncontrolled eye movements. People with nystagmus experience side to side eyeball movement, up and down movement, or “rolling” eyeballs. For this reason, nystagmus is sometimes referred to as “dancing eyeballs.” Symptoms of nystagmus may present in one or both eyes.

Sudden death: The most fatal effects of stroke affect the brain stem, which controls autonomic functions (functions not under voluntary control) like breathing. Sudden death can occur if the stroke interferes with breathing functions. The stroke causes a sudden collapse, and emergency medical treatment is required. Even with medical treatment, many brain stem strokes result in sudden death.

Posterior Stroke and Vision: Miosis, Ptosis, and Horner’s Syndrome

Damage to the brain’s visual center (the occipital lobe) can result in a number of conditions. Blindness may occur in either eye, or in both if stroke damage is extensive. Ophthalmoplegia, or an inability to move the eyeball, can also occur.Ptosis, or droopy eyelids.Horner’s syndrome affects the muscles around the eye, causing symptoms such as ptosis and miosis. Ptosis refers to a “droopy eyelid.” Miosis describes an involuntary contraction of the pupil. These features are illustrated in the left eye of the woman pictured here. The presence of either ptosis or miosis should lead to an investigation of a possible stroke.

Lacunar Symptoms

Symptoms of a lacunar stroke are generally more limited than anterior or posterior strokes. Lacunar stroke symptoms tend to affect only the brain’s motor functions, without loss of “higher functions” such as speech, vision, or mental processes. Limited paresis (muscle weakness) is often one of the symptoms of lacunar stroke.




Mayo Foundation for Medical Education and Research. (2003). Stroke. Retrieved February 11, 2004, from 821670F1635148