1412 - Acquired Stuttering after CVA

Case Diagnosis: CVA

Case Description: 62-year-old male history of multiple strokes within a year, presents to our acute inpatient rehabilitation (AIR). Ten months prior to AIR, he had a left parietal infarct and developed stuttering which subsequently improved. Seven months prior to AIR, patient had a CVA involving the left parieto-occipital, left posterior temporal, and right occipital lobes. Brain MRI for AIR admission showed new scattered foci of supratentorial focal infarcts involving right occipital, parietal, and left high frontoparietal lobes. Stuttering worsened significantly with presenting CVA along with worsening right-sided weakness. Patient reported he was unable to fluently articulate, stuttering on certain sounds and words when excited or speaking quickly. Speech language pathology evaluation demonstrated 18 occurrences of dysfluent speech over a 3-minute period, marked by initial syllable repetitions and prolongation, specifically glottal sounds of ‘k’ and ‘g,’ with some word and phrase repetitions.

Discussions: Patient was taught stuttering modification and fluency-enhancing strategies, and was able to implement them independently. Easy onsets and tapping out syllables proved to be the most effective in improving fluency. On reassessment upon discharge 2 weeks later, patient demonstrated fluent speech with 97% accuracy while utilizing strategies, with dysfluency noted on 2 words. In structured conversation, patient used slow speech with minimal initial syllable repetitions. In unstructured conversation, patient had some syllable repetitions, improved with verbal cueing. Unlike this case, the left caudate is the lesion site most often reported in the few described cases of acquired stuttering after stroke. The repetition of a syllable in stuttering likely comes before the original enunciation can be fully processed, perhaps indicating an efferent copy sent for speech as it is for other motor commands.

Conclusions: Acquired stuttering may be under-reported sequelae of stroke. Speech therapy in AIR can be beneficial. Further studies of clinical aspects of acquired stuttering and neuroscience implications are warranted.