TRANSIENT NEURO-SPEECH DYSFLUENCY FOLLOWING SUBARACHNOID BLOCK FOR EMERGENCY OBSTETRIC INTERVENTION IN A MORBIDLY OBESE PARTURIENT: A COMPREHENSIVE CLINICAL ANALYSIS

ABSTRACT This comprehensive case report documents a rare and complex occurrence of transient, late-onset acquired stuttering in a 27-year-old morbidly obese primigravida following the administration of spinal anesthesia for an emergency cesarean section in South West Nigeria. Despite a technically successful subarachnoid block at the L3/L4 interspace and the delivery of a healthy neonate with excellent APGAR scores, the patient developed a marked speech dysfluency exactly seven minutes post-delivery. The patient presented with a Body Mass Index of 44.27 kg/m² and a history of pregnancyinduced hypertension, necessitating a deep analysis of her unique physiological landscape. The stuttering was accompanied by observable restlessness in the upper body and head, consistent with akathisia, yet notably lacked any focal motor or sensory deficits in the extremities, ruling out a total or high spinal block. The symptoms resolved spontaneously within 15 minutes without pharmacological intervention. This report explores a multifactorial aetiology involving the dopamine-antagonist effects of metoclopramide, a relative local anesthetic overdose facilitated by obesityinduced alterations in cerebrospinal fluid (CSF) dynamics, and transient cerebral hypoperfusion in a brain with rightshifted autoregulation. This case serves as a sentinel reminder for obstetric anesthetists to maintain a high index of suspicion for atypical neuro-pharmacological reactions in the high-risk parturient.