Acute-Onset Stuttering as a Stroke Mimic

Background and purpose: The acute onset of stuttering in an adult is not uncommon and rarely is caused by ischemic stroke. A neurologist is likely to encounter this presentation and it is important to identify distinguishing features between ischemic stroke and other causes. Adult-onset acquired stuttering is classified as either neurogenic if secondary to brain injury or psychogenic in the absence of structural brain lesions. There are particular features of dysfluency in acquired stuttering that are distinct from developmental stuttering. Clinical presentation: We present a case of a 35-year old woman without a childhood history, who had witnessed acute onset of stuttering which resulted in arrival in the emergency department and activation of the acute stroke team. She progressed to muteness and then improved to a phenotype of neurogenic stuttering. She had almost fully recovered by hospital discharge, however her stuttering recurred consistent with psychogenic stuttering. The diagnosis was confirmed at 6 month follow-up. Conclusion: This case is notable because of the evolution the phenotype and the absence of an obvious culprit lesion or obvious psychological precipitants.