Rare and Mysterious Speech Disorders in Acute Stroke:A Prospective Observational Study

Abstract

Background: Rare motor speech disorders in acute stroke, including aphemia, foreign accent syndrome, acquired stuttering, and opercular syndrome, are often misdiagnosed as aphasia despite preserved comprehension and writing skills. Early recognition is crucial for targeted therapy and accurate lesion localization.

Aim: To identify and characterize rare motor speech disorders in acute stroke, document their lesion correlates, and compare findings with existing literature.

Methods:This prospective observational study included acute stroke patients with speech-output impairment but preserved comprehension and writing ability, admitted between June 2023–December 2024. Diagnosis was made using a structured bedside protocol. MRI lesion mapping was performed for all patients.

Results: Thirty patients (mean age 58.2 ± 11.7 years; 18 males) were included. Ischemic stroke occurred in 24 (80%) and hemorrhagic stroke in 6 (20%). Apraxia of speech and dysarthria each occurred in 33.3%, aphemia in 13.3%, opercular syndrome in 13.3%, foreign accent syndrome in 3.3%, and acquired stuttering in 3.3%. Lesions were syndrome-specific.

Conclusion: Rare motor speech syndromes in stroke can be identified at the bedside when comprehension and writing are intact. Lesion mapping supports distinct neuroanatomic substrates for each disorder, in agreement with previous studies.