What is the term for stuttering that occurs after a stroke?

Neurogenic Stuttering

The term for stuttering that occurs after a stroke is "neurogenic stuttering" or "acquired neurogenic stuttering." This is a distinct acquired speech disorder characterized by stuttering-like dysfluencies that develop following brain damage 1.

Definition and Characteristics

Neurogenic stuttering is fundamentally different from developmental stuttering. It represents an acquired disorder of speech fluency that emerges after stroke or other forms of brain injury 2, 3. The condition is characterized by:

• Stuttering-like dysfluencies that were not present before the neurological event
• Disruption of fluent speech production
• Can occur with or without other communication disorders like aphasia or dysarthria

Neuroanatomical Basis

The pathophysiology of neurogenic stuttering does not localize to a single brain region but rather involves disruption of a cortico-striato-cortical network. Research demonstrates that stroke-induced neurogenic stuttering results from lesions affecting 2:

• Inferior frontal cortex
• Superior temporal cortex
• Intraparietal cortex
• Basal ganglia
• White matter interconnections (superior longitudinal fasciculus and internal capsule)

The evidence indicates that neurogenic stuttering can occur following lesions at any point throughout this integrated speech network 2, 3. Both cortical and subcortical lesions have been documented, including:

• Left hemispheric cortical lesions (most common)
• Subcortical structures (basal ganglia, internal capsule)
• Pontine lesions with cerebellar involvement 4
• Left parietal infarctions 5

Clinical Recognition

Healthcare providers should be trained to recognize neurogenic stuttering as distinct from other post-stroke communication disorders 1. The Canadian Stroke Best Practice guidelines specifically recommend that all healthcare providers working with stroke patients be trained about communication disorders including:

• Aphasia (language disorder affecting comprehension and production)
• Dysarthria (motor speech disorder)
• Apraxia of speech (motor planning disorder)
• Neurogenic stuttering (fluency disorder)

Screening and Assessment

All stroke patients should be screened for communication disorders using a simple, reliable, validated tool 1. When neurogenic stuttering is suspected:

1. Immediate referral to a Speech-Language Pathologist (SLP) is indicated 1
2. Assessment should evaluate multiple domains: speaking fluency, comprehension, reading, writing, and functional communication
3. Distinguish neurogenic stuttering from dysfluencies associated with aphasia or dysarthria 6

Important Clinical Pitfall

New-onset episodic stuttering in adults should prompt urgent evaluation for stroke. A case report documents a patient presenting with isolated brief episodes of stuttering as the sole manifestation of acute ischemic stroke 3. This emphasizes that:

• Recurrent episodic stuttering without other neurological signs still warrants neuroimaging
• Stuttering can be the presenting symptom of stroke before other deficits emerge
• Do not dismiss isolated stuttering as a benign speech problem in adults

Management Approach

While the guidelines focus primarily on aphasia management, the principles apply to all post-stroke communication disorders 1:

1. Early assessment by a Speech-Language Pathologist
2. Intensive therapy as tolerated (evidence supports early intervention)
3. Functional communication strategies and compensatory techniques
4. Communication partner training for family members
5. Assistive technology when appropriate

The prognosis and specific treatment protocols for neurogenic stuttering remain less well-defined than for aphasia, reflecting the relative rarity of this condition compared to other post-stroke communication disorders 6.