Distinguishing psychogenic from neurogenic dysfluency when neurologic and psychologic factors coexist

Reports of acquired dysfluency emphasize the diagnostic importance of symptom reversibility in distinguishing a psychogenic from a neurogenic etiology. This paper describes the onset of dysfluency in a 23-year-old man who had anoxic encephalopathy with diffuse weakness and spasticity, pseudoseizures, and depression following an episode of status epilepticus. Differential diagnosis was complicated by the presence of both objective neurologic abnormalities and psychologic factors. The history, physical examination and analysis of speech characteristics were insufficient to make the diagnosis; however, the effect of a therapeutic trial strongly suggested psychogenicity.