Background: Anarthria is a rare neurological disorder that may mimic malingering or functional neurological conditions when it presents without other obvious neurological deficits. Accurate diagnosis is essential to avoid misclassification and ensure timely treatment. Case Presentation: A 64-year-old incarcerated African American male experienced the sudden onset of inability to speak. Although he was unable to articulate words, he retained the ability to understand language, mouth words, and communicate through writing. Neurological examination was largely unremarkable except for mild appendicular dysmetria, and psychiatric evaluation did not suggest malingering or other psychiatric illness. Brain magnetic resonance imaging (MRI) demonstrated acute bilateral ischemic infarcts in the left corona radiata and right centrum semiovale, along with chronic microvascular ischemic changes and multiple cerebral microhemorrhages. Swallowing assessment also revealed mild-to-moderate oropharyngeal dysphagia. Discussion: The patient's isolated speech impairment was attributed to acute bilateral ischemic strokes superimposed on extensive chronic cerebrovascular disease, resulting in physiological anarthria rather than malingering. Supportive imaging findings and clinical evaluation were crucial in establishing the diagnosis. Following speech rehabilitation, the patient gradually regained the ability to vocalize his name and simple words over the course of one month. Conclusion: This case highlights that isolated anarthria can be an uncommon presentation of bilateral ischemic stroke and may be mistaken for malingering. Comprehensive neurological assessment, neuroimaging, and multidisciplinary evaluation are essential for accurate diagnosis, appropriate management, and improved functional recovery.
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*Address for Correspondence: Andrew Wilner, The University of Tennessee Health Science Center, Neurology; Regional One Health, TenReceived: 04 April 2022; Accepted: 05 May 2022; Published: 08 May 2022 Citation of this article: Dennis-Vacheron, M., Dao, T., Jordan, K., Joshi, A., Wilner, A. (2022) Anarthria vs Malingering: An Unusual Case.
Copyright: © 2022 Andrew Wilner, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
nessee, USA; E-mail: awilner@uthsc.edu Arch Clin Case Rep, 5(1): 07-08.
A 64-year-old incarcerated African American male suddenly lost the ability to speak. The isolated nature of his symptoms raised the question of malingering [1]. Past medical history included asthma, hyperlipidemia, hypertension, a gunshot wound to the right foot, and polysubstance and tobacco abuse. Physical examination was normal. Affect was pleasant without spontaneous laughing or crying. On neurological examination, he grunted but was unable to articulate. He could mouth words, write, and understand. Cranial nerves, including tongue movements, were normal. He had mild appendicular dysmetria. Psychiatric evaluation did not suggest psychopathology. Cognitive Assessment for Stroke Patients (CASP) score was 28/30.
Brain MRI revealed punctate areas of acute diffusion restriction in the left corona radiata and right centrum semiovale consistent © 2022 Somato Publications. All rights reserved.
with acute ischemic strokes (Figure 1). Global atrophy, cortical and subcortical microhemorrahges were also present (Figure 2). Brain and neck CTA did not reveal significant stenosis or vasculitis. Transthoracic and transesophageal echocardiograms were unremarkable. Bedside fiberoptic swallow examination demonstrated moderate oropharyngeal phase dysphagia with intermittent laryngotracheal aspiration with thin liquids, loss of control of bolus prior to swallow, and laryngeal penetration variably cleared during swallow.
We concluded that the patient’s acute bilateral strokes superimposed on his high burden of microvascular ischemic and hemorrhagic lesions resulted in physiologic anarthria with mild dysphagia rather than functional illness [2]. Over the next month he received speech therapy and gradually recovered the ability to vo-
