STUTTERING
AS A SPEECH DEFICIT IN STROKE
M. Cao, M. Rasura,
A. Anzini, M. Ferrari and C. Fieschi
Dept. of Neurological Sciences, University of Rome " La Sapienza"
Stuttering is rarely associated with stroke.
We present the case of a 34-year-old, right-handed woman, affected
by cerebrovascular disease thought to be caused by systemic vasculitis, who presented a
language disturbance characterized by stuttering as the only manifestation of a brainstem
infarction.
Her mother was affected by diabetes mellitus, myocardial infarction
and hypertension.
The patient suffered from dysmenorrhea, treated with oral
contraceptive therapy.
In October 1994 she suffered a motor deficit in the right arm,
lasting a few minutes; the patient was not submitted to any clinical examination.
In December 1994 she presented mild fever and pharyngalgia which
were treated with antibiotic therapy. In the same period she developed vertical
gaze palsy, right arm deficit and dysarthria which lasted some months. She was admitted to
hospital where she underwent an EEG, which revealed theta and delta waves in the central
right hemisphere, and a brain CT, which showed bilateral ischemic small areas in the white
matter of the corona radiata. Following the suspected diagnosis of vasculitis, in February
1995 the patient was submitted to a brain angiography, which showed bilateral internal
carotid artery occlusion. She started steroid therapy.
In July 1995 the patient presented a speech deficit characterized by
stuttering. She underwent a neuropsychological test which showed only a mild comprehension
deficit (a score of 28 at the Token test). A brain MRI, performed two months later, showed
multiple ischemic lesions in the right caudate nucleus, in the white matter of semiovale
centrum, in the left cortex and in the brainstem. She also underwent autoantibody assays
which revealed slightly high (++) antinuclear antibodies values.
Stuttering is an abnormality characterized by interruption of the
normal rhythm of speech by involuntary repetition, and prolungation or arrest of uttered
letters or syllables. Some authors describe (1) stuttering as the result of aphasic
disturbance. Acquired stuttering is transitory in many cases or permanent if the lesions
are bilateral (2).
Althought it is rare for an individual to start stuttering, there
are some reports of fluent people who develop this disturbance after a brain injury,
whether cortical or subcortical (3). Stuttering is also occasionally observed in adults as
a result of a left hemispheric lesion in the Broca area (4).
References:
1) Rosenbeck J, Messert B, Collins M et al: stuttering
following brain damage. Brain Lang, 6:82: 103-138, 1975.
2) Helm NA, Butler RB, Benson DF: Acquired stuttering.
Neurology, 28:1159, 1978.
3) Rosenfield DB, Viswanath NS, Callis- Landrum L et al:
Patients with acquired asynfluencies: what they tell about developmental stuttering. In
HFM Petrs , W Hulstijn, CW Starkkweather ( eds), speech Motor control and stuttering.
Amsterdam: Excepta Medica, 1991: 277-284.
4) Lanoe Y, Pedetti L, Lanoe A et al: Aphasia caused by
isolated lesion of the semi-ovale centre, Rev. Neurol. Paris, 150: 430-4, 1994.
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