Anarthria vs Malingering: An Unusual Case

Abstract

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.