Could speech problems be all related to the MVA from 34 years ago or something new?

[Graydove]

When I was 12 I was in a MVA causing TBI and a 3 day Coma, I’m now 46
I was a charge nurse caring for 24 skilled need clients, a very stressful job. I started having headaches, then mild speech and writing difficulties. I had trouble concentrating and connecting things to the right time of day, I had trouble even giving medications at the correct time, I would look at my watch and then at the MAR and not be able to connect to the time it was.
03/21/07 I ended up in the ER at the local hospital having a CT and labs done. The next day I go and see my PCP. He tells me my speech resembles someone learning a new language. He wants an MRI done. I saw a neurologist; she didn’t have recent CT or MRI in her office. I have a copy of her notes: she refers to a CT I had a year ago when I was having some problems with one of my hands going numb. Anyhow the note refers to showing traumatic frontal lobe changes. I don’t know if this is from the damage done from the MVA or if it is more recent, this was not specified.  She also describes my speech initially to be slightly slow and stilted and then changes to more of a child-like talk so that I would say "I flew over truck", "Naproxen all gone", "bottle say 75mg.". A month later I was able to get most of my speech and writing back to almost normal. I still find myself slipping at times with any increases in stress.
Is this stress, old TBI related or maybe both?
Will it ever go away completely?
What can I do about it?

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
    Traumatic brain injury, especially from motor vehicle accidents, causes damage to the frontal lobes and sometimes the temporal lobes as well.  This often leaves a scar that will be there for life.  The functions of the damaged areas can often move to other adjacent areas, but can be more likely to fail if stressed.  The most concerning possibility is that seizures can arise from the scar and cause focal frontal seizures that can also cause the symptoms that you describe, including confusion, disorientation, headaches and speech problems.  I would recommend that you get an EEG (brain wave test) to evaluate for seizures.  It would be best to get the EEG when you are having one of your confusion episodes, but if that is not possible I would recommend a 2 hour sleep deprived test.  If you continue to have repeated episodes like you described I would recommend a trial on an anti-epileptic drug (such as Topamax) that will work for seizures and migraine prevention as well.
I hope this has been helpful.

[vega1318]

Wow, for someone who had such a severe speech problem relapse - you sound pretty good in print!  There are many cases reported and observed  indicating that old (even very old) traumatic brain injury impairments may come back under specific circumstances:  stress, medications, infectious are all included.  However, old injury could also cause minor seizures and you should checked for those.  The former being rare, i think you should let your doctors check you out just in case with whatever else they may have in mind before chalking it up to stress effects.    By the way, migraine (even if you never considered yourself a headache person) can also present with a similar picture.

[Capital H]

I am certainly not qualified to comment, but what I can share is my own experience.

Some years ago after psychological testing, a clinical psychologist told me that a number of my problems were consistent with having had some early brain damage to the left hemisphere. Since I have never had my brain scanned, I cannot confirm that hypothesis however it is certainly not impossible given as I nearly died from pneumonia when I was 7 months old and if the lack of oxygen didn't get me, then the heavy doses of streptomycin that were given back then could have done.

What does happen to me under situations of extreme stress and overload is that my speech fades, to begin with I will stutter and after that my speech will become more and more telegraphic in that I lose the ability to use conventional grammar, after that it becomes quite aphasic in that I could not even write down the right  words to use as I am in a land of picture language only.

This is a frightening situation to be in when it happens, because of the difficulties in communicating, often when communication is important, however it is not one that concerns me unduly as it is an old problem indeed that goes way back to my childhood.

[Graydove]

Now I wonder if some kind of TIA. It not quick, last many days sometimes, it start again last night, strange feeling head on right side mostly. Like something crawling under my scalp. Sometimes like band circle my head, not hurt. just feel strange, now have trouble with words again, I talked with my mom yesterday, I have to say same sentence 4 times for her to understand, when say words, letters and sounds in words get tangled up. Feel like split down center two pieces, glue not hold together. Do have annoying pain in right jaw and right back of head, not big pain though. I tired most time now,
Can this be some kind of stroke, but not leave big, effect, but I think each time have more loss and not get as much back each time.
I 46 have had trouble with BP go to high sometimes, but not on Antihypertensive meds now, not been on before either.
Thank you Sheila

[Capital H]

Unfortunately I am not a medic, and I don't know what it is like to have a TIA. I do know that the way you have just written is very like what happens to me under extreme stress, in that it seems I unlearn all the fancy ways to use language, connect it up, be fluent, grammar, all of that stuff you learn in school because it is taking maximum effort just to communicate in a verbal form at all.

I am dyslexic so have to admit my command of grammar is not all that great most times anyway, but I would reckon that whenever you have some underlying difficulty with anything, stress is going to make it even harder to do, also fatigue can impact that.