Progressive dysfluency associated with right hemisphere disease.

A late onset progressive dysfluency following a right hemisphere stroke occurred in a 62-year-old male. Dysfluency was characterized by pronounced word and phrase reiterations, and sound and syllable reiterations to a lesser degree. Spontaneous speech was significantly more dysfluent than oral reading and repetition. Recitation and singing were minimally dysfluent. Reiterations were accompanied by reduced vocal loudness and increased rate of speech. Reiterations occurred in initial, medial, and final sentence position. Secondary symptoms such as facial grimacing were absent. In contrast to acquired cortical stuttering which is characterized by a preponderance of sound and syllable sentence initial repetitions, dysfluency was more closely characteristic of palilalia. The dysfluency occurred as a symptom of a diffuse nonspecific subcortical projection system defect related to massive infarction in the right middle cerebral artery distribution with associated atrophy.