Acquired Transient Stuttering During a Migraine Attack

Abstract

Stuttering is an abnormality in the fluency of speech, which is characterized by interruption of the normal rhythm due to involuntary repetition and prolongation, or arrest, of uttered letters or syllables.The aphasic syndrome and dysarthria can be associated with classic migraine, but, to our knowledge, no study has so far described stuttering as the only neurological symptom accompanying an attack.Key words: stuttering, migraine, aphasia ( Headache 2000;40:170-172) CASE HISTORYA 26-year-old, right-handed woman presented to the emergency room because of frontal and temporal bilateral headache and stuttering.The patient had been well until three hours before when she developed a severe headache and right arm and perioral paresthesia with a progressive disturbance in the fluency of her speech with stuttering.She had never stuttered previously, and there was no family history of developmental stuttering. The patient reported having had insulin-dependent diabetes mellitus since the age of six years and only had one or two episodes of headache per year in the past; these headaches had the same features as the current episode except for the stuttering. There was no history of hypertension; use of tobacco, alcohol, or illicit drugs; auditory symptoms, vertigo, or dysarthria; neck pain; night sweats; or weight loss.Her temperature was 36.5 Њ C. Her pulse was 88 beats per minute, and the respirations were 16 breaths were minute . Her blood pressure was 115/80 mm Hg.The results of the general physical examination were normal. On neurological examination, her muscle strength, sensation of pinprick, vibration, temperature, and joint position were normal; cranial nerve functions were preserved; and the visual fields were intact. Coordination and gait were normal, and Romberg's test was negative. The deep or tendon reflexes were ϩϩ and equal in both arms and legs. Babinski's sign was not present.The fluency evaluation revealed severe stuttering characterized by multiple repetitions or blocks, or both, with 20 or more repetitions per word during both conversational speech and oral reading. No starters or secondary stuttering characteristics, and no specific word fears or avoidance, were exhibited. No deficit in naming, spontaneous speech, comprehension, repetition, reading, and writing was observed.Blood glucose levels and other hematological and chemical values, including the level of angiotensin-converting enzyme, were normal.The results of a CT examination of the brain, performed during the attack, were normal, and EEG findings did not show abnormalities or focal or generalized paroxysmal activity.Ketoprofen was administered with only a slight improvement in the patient's symptoms, but stuttering, headache, and right arm and perioral paresthesia promptly and completely disappeared after subcutaneous administration of sumatriptan, 6 mg.One week later, a repeated CT and MRI of the brain performed after the intravenous injection of contrast material did not show any abnormality. A serological test for syphilis and a test ...

A clinician survey of speech and non-speech characteristics of neurogenic stuttering

“…For instance, Leder (1996) has described a patient with Parkinson's Disease who showed no specific word fears, no secondary stuttering characteristics, no adaptation effect and who stuttered equally on all types of speech. The patient described by Perino et al (2000) also stuttered during conversational speech and oral reading, had no secondary stuttering characteristics and no specific word fears. In contrast, other case studies have demonstrated that not all patients with neurogenic stuttering may conform to all of the suggested differential characteristics.…”

“…Based on published data, this acquired form of stuttering is most often associated with stroke (Jokel, De Nil, & Sharpe, 2007;Sahin, Krespi, Yilmaz, & Coban, 2005;Van Borsel, Van Der Maede, & Santens, 2003), traumatic brain injury Ludlow, Rosenberg, Salazar, Grafman, & Smutok, 1987;Yeoh, Lind, & Law, 2006), neurodegenerative disease (Koller, 1983;Leder, 1996;Mowrer & Younts, 2001), or another neurological event that affects brain function (Byrne, Byrne, & Zibin, 1993;Movsessian, 2005;Perino, Famularo, & Tarroni, 2000;Tsao, Shad, & Faillace, 2004). Although neurogenic stuttering behaviorally appears to have a lot of similarity to developmental stuttering, a number of authors have suggested several features which may differentiate it from developmental stuttering.…”

Sudden onset stuttering in an adult: Neurogenic and psychogenic perspectives

“…However, we need to consider the possibility that either pain, in itself, could potentially provide the ''trigger'', or that the trauma of the condition could have set up the stress condition that allows the stutter to appear, and then with the chronic nature of the condition, persist. Again though, if we were to accept that this case represents, some kind of ''pain induced'' stutter, it is unclear why, when the pain was controlled, the stutter did not resolve or improve, as reported in both the two cases mentioned earlier (Perino et al, 2000;Ward, 2006).…”

“…There are some anecdotal reports of pain potentially being associated with acquired stuttering. Perino, Famularo, and Taroni (2000) reported transient stuttering in an individual during a migraine attack. Ward (2006) also reported the case of apparent PS in an individual suffering from chronic and intense back pain.…”

Recurrent Wernicke's Aphasia: Migraine and Not Stroke!

“…Aphasic changes occur more frequently (47%), are more severe, and last longer when associated with hemiplegic migraine 6 . The language or speech symptoms occurring during a migraine attack with aura appear to be hard to categorize, 1 but include dysarthria, 1 stuttering, 7 nonfluent or Broca's aphasia, 8,9 and anomia 4 …”