Disentangling a Functional Speech Disorder in the Context of another Neurological Disease: A Case Report

This clinical case describes the communication profile of a functional speech disorder. A 48-year-old woman was admitted to the emergency service due to sudden changes in speech, generalized dystonia and gait ataxia. Magnetic resonance imaging showed multiple supra and infratentorial inflammatory lesions involving the posterior occipito-temporal lobes bilaterally, frontal convexity bilaterally, insula and paramedian frontal cortex on the left, diencephalon, rhombencephalon. On the third day, a speech pathology evaluation was conducted, revealing inconsistencies in speech: repetitions of initial sounds, without characteristics of an acquired stutter, a clenched articulation, not justified by an orofacial motor disorder, an inconsistent pattern in voice and prosody. Three days later, another assessment was carried out, showing a significant improvement in speech intelligibility. There was a marked variability in speech features defects found over the days, as well as in their severity. These behaviors appear simultaneously with a speech pattern that is not justified by any of the neurological lesions found.