Speech disorder following CHI

    
      Re: Speech disorder following CHI
    


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Posted by CCF NEUROSURGERY MD on October 07, 1997 at 12:02:29:

In Reply to: Speech disorder following CHI posted by Randy Beckett on October 01, 1997 at 11:12:27:

: Hi,
  In January, 1996 my wife, Cloice,  hit her head on a 2x6 that was nailed across a doorway at a construction site.  She was unconscious for 45 minutes and seizured during that time.  She had severe headaches for several weeks, had some stuttering, dizziness and memory difficulties.  She has had neuropsychological testing which revealed a 30-40% cognitive impairment s/p CHI.  She still has frequent HA, EMA,  memory difficulties, word retrieval problems and problem solving difficulties.  Most significantly over the past 8 weeks she began to stutter again and about 6 weeks ago it became severe.  She not only stutters on the first syllable of every word but also cannot volumatirly stop prolonging her stuttering on last  syllables.  She also cannot pronounce middle word hard consonant sounds.  Her speech is high informational content.  Speech therapy is having some positive effect but not much.  She also had lost some sense of taste and smell.  Neuro exam is grossly normal. Head  MRI after the injury and within the past month is normal.  Her voice does not have the strangled quality of spastic dysphonia but is severely disfluent.  She had been taking Klonipin (klonopin) at night for sleep, but we suspect that it is further impairing her memory.  She has just switched to Paxil.  She has mild-moderate depressive symptoms.  She was prior to this a very successful residential builder and real estate broker.
  Do you know of anything  in the literature about disfluencies following CHI?
  This far out?
  Any ideas on neuropathology?
  Who (department, Physician) at CCF would we contact regarding an evaluation?
  A Oral-miaxillo-facial surgeon friend of our just returned from a meeting at which a Dr. Hunter from CCF presented regarding speech pathology.  Do you know him?
  Thanks very much for your help.
  Randy Beckett
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Dear Randy,
Closed head injuries can be difficult.  A good bet may be that your wife
suffered a contusion, essentially a bruise, on the brain.  This might explain
the seizure immediately after the incident and the subsequent problems with
speech in the past 21 months.  A contusion on the brain will eventually
form a scar that may interfere with normal function.  Given that your wife
has speech difficulties one would surmise that the contusion was in the
area of the temporal lobe on the left.  This is, of course, guesswork based
on what most commonly occurs in this type of situation.  The real answer
lies in the CT scan that was done at the time of your wife's injury.  The
doctors that took care of your wife at the time would be your best resource
for this information.
Should you desire an evaluation at the Cleveland Clinic, an appointment can
be made at the Neurology desk by calling 800-223-2273.  Ask for the Neurology
desk.  Any previous hospital notes and CT or MRI films would be very useful.  
The Cleveland Clinic has many excellent speech pathologists that may assist
in your wife's recovery.
Good luck.