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Forum Name: Neurology Topics

Question: Sudden Onset Speech Disorder


 mimiy2k - Thu Jun 14, 2007 8:34 pm

I have been to a few doctors, had a normal EEG, MRI, and ultrasound of Carotid Artery and had a Treadmill Test with color live pictures (an MRI?). All were normal.

No one has an answer for me about my symptoms wgich I will describe in a few moments.

I am 57 year old woman, healthy except for type II Dianetes being managed by Metformin, Glymepride and Avandia. I take Atenelol just as a precaution due to my diabetes (I am mid-high normal on BP readings). My bad cholestral is very low.

I also have low B12 and take monthly shots. My doictors hypothesize it is due to Pernicious Anemia but Schilling test was inconclusive. My older sister gets B12 shots theorized due to PA as did my Mom. Now here's the strange thing.

I have had low B12 counts OFF AND ON all my life. Sometimes my B12 count is normal and other times it is very low (both when I am not taking B12 shots).

When I was age 11, my tosilectomy was postponed day before due to low HCT Count (and i have never been iron deficient). When I was 47, my Gall bladder removal surgery was postponed for EXACTLY same reason. Then on re-test, which I requested, it was normal and they rescheduled the surgery. When I was 21, my college health service wrote off my low HCT as Mono, the disease of the day.

For at least 10 years since being diagnosed with Type II Diabetes, I have had bl;ood work done at least 4X a year. About 1 in 4 shows very low B12 then the others will be normal.

Different years, labs, doctors.

It seems odd to me that low B12 would come and go when I wasn't on B12 shots over a number of years unless it is indicative of some sort of known disorder.

I am tired always (but have sleep apnea which may explain that).

I mention the low B12 because I know this can affect the brain in case the symptoms I am going to describe might bear a relationship to this.

Here they are:

About 24 months ago, I suddenly had troubling getting my words out when speaking. It srtarted sort of like stutter (which I have never had) but progressed to a stammer over time. This progressed to barely discernable speech (starts as a stammer, becomes indiscernable).

I hear the way it sounds to otjhers, and on a tape recorder, in my brain but I feel I am forming the words like I always do. They just do not come out of my mouth right. It sounds labored and as if my words are being slowed to an unnaturally slow speed by a tape recorder and I the pronounciations do not sound right and are not easy to understand.

Three doctors have heard me speak this way on the spot because it happens MOST OFTEN when I am the SLIGHTEST BIT anxious or stressed which I guess must happen when I discuss this with my doctors.

It may happen off and on all day, not happen again for 2 weeks, or can come out of nowhere when I have no awareness of any stress or axiety -- but definitely is more often triggered by stress even just by someone talking over me or interrupting me.

Again, my thoughts are clear.

My only other possible Neuro symptom, is that I get a numb, pins and needles or burning feeling when I move either thumb outward very much. I have had pins & needles come and go in my hands and feet over the years (lasting for months then going away for years).

My sister has MS but my MRI was clear. My nephew has Neurofibromitosis.

Before she died, my Mom told us that she had some sort of hereditary disorder that was deter,mined from a test where they froze her blood (She was diagnosed with Pernicious Anemia). I was in my early 20s when she died so never pursued what that diagnosis was.

These are all the pieces of the puzzle I know to provide. The talking disorder has changed my quality of life because I never know when it is going to trigger and I sound like I am a low to mid-functioning Mongoloid (I mean this respectfully), or that I am rertarded, when I speak during an episode of this. So I am afraid to participate in business calls now. I am self-employed and this is impacting my income since I now avoid sales calls.

Any other tests anyone can recommend, specialists i should see or theories?

THANK YOU SO MUCH FOR YOUR HELP. THE DOCTORS I HAVE SEEN ARE STUMPED.

Best,
Mimi
 Dr. K. Eisele - Mon Jul 02, 2007 1:25 pm

User avatar Dear mimiy2k:

First of all, this post assumes that brain tumor, strokes, etc., have all been ruled out.

The thing that stands out most, I think, is the diabetes. Diabetes can cause "nerve problems," like the pins and needles, numbness, or burning, that you described. This condition is known as peripheral neuropathy.

Diabetes can also cause a different kind of neuropathy, called autonomic neuropathy. Autonomic neuropathy can present with many really unusual symptoms, such as orthostatic hypothension, when your blood pressure falls if you stand up too quickly (you feel dizzy when you get up). The autonomic nervous system affects systems of which you have no volitional control. The fight or flight response is one of them. I think it is possible that this is the cause of your problem--you mentioned that the stuttering/stammering occurs most often when you are nervous. The other times the problem occurs could be due to your self-consciousness about the problem. Perhaps you anticipate that you will become nervous, thereby triggering the anxiety, and the speech difficulties.

There are a number of treatments that are helpful, but not curative. Treatment is most often an anticonvulsant medication--these are used because they have neuroprotective and some have some neurotropic properties. This means that they can help repair certain types of nerve injuries.

Another possibility is that you have what is called microvascular ischemia. This is also a common consequence of diabetes. This is a lot like having multiple mini-strokes, which you would not even be aware were happening. Over time, these "events" add up to cause noticeable changes. However, the intermittent nature of your symptoms probably makes this less likely. On the other hand, it seems at least within the realm of possibility that each episode you have is the result of one of these microvascular "events," which would be difficult to pick up on imaging.

I hope this is helpful to you. Please come back and let us know how things go for you.

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