Sudden onset of "stuttering" in an adult: neurogenic or psychogenic?

A 30-year-old woman hit her head during an automobile accident and was admitted to the hospital. One week later magnetic resonance imaging (MRI) showed a right frontal/parietal lesion. Among the behavioral sequelae were mild ataxia with trunkal instability and dysfluent speech accompanied by prominent shaking of the right leg, face and neck tension, and facial twitching. The speech-language pathologist thought the patient was not aphasic but rather was stuttering and treated her for about a month with pacing and "easy onset" techniques to which she showed fair response. The diagnostic question in this case is whether the stuttering was the result of the brain damage (neurogenic) or of the stressful events she had experienced (psychogenic). In this article we review her case and the process we used in arriving at an "expert" opinion.