Foreign Accent Syndrome: A Case Report With Multiple Accents

Karaman S. , Clinic, Cekirge State Hospital, Bursa, Turkey, Maner A.F. ,Department of Child Development, Kirklareli University, Kirklareli,Turkey, Hakyemez B. Department of Radiology, Uludag University Medical School, Bursa, Turkey

Foreign Accent Syndrome (FAS) is a motor speech disorder in which the pronounciation of a patient is recognized by listeners of the same community as distinctly foreign [1]. Medical literature suggest that there are three main types of FAS: neurogenic, psychogenic and mixed [2]. FAS is often caused by a as our case.

The patient, 63-year-old male of Turkish descent, was first submitted with blurred vision and headache complaints. After ophthalmology examination with no pathologic finding, he was referred to the department where cranial Magnetic Resonance Imaging (MRI) and Digital Subtraction Angiography scans showed a wide necked aneurysm at the level of the left MCA bifurcation about 9 mm in size. Embolization for left MCA complex aneurysm was performed with the Y Stent technique.Upon development of dysphasia immediately after aneurysm treatment, thromboembolic occlusion of the left MCA lower trunk was detected on angiographic images and TPA infusion and selective thrombolytic therapy applied. In the control angiography it was observed that the stenosis and thromboembolic status in the left MCA subdivision were completely disappeared.

Following his post-operative recovery, patient’s speech was impaired.It was first noticed by interventional radiologist and his relatives that the accent was changed. Five months after the procedure, he applied to psychiatry clinic with speech impairment complaints and increased talking volume. In preliminary examination; patient was thought to be of foreign national who speaks Turkish as a second language. However detailed story revealed that his mother tongue was Turkish and that his accent after the intervention was changing frequently throughout the day. Among the accents he used so far are Macedonian, Greek, Azeri accent and Black Sea dialect accent. He has never learnt a foreign language except English and never been to a foreign country except Azerbaijan.In his and family’s medical background no psychiatric illness was reported.

In neurogenic FAS, although the exact mechanism is unclear, there are damages from a stroke or traumatic brain injury [3]. Vascular lesions usually involve the middle cerebral artery and motor speech areas such as precentral and middle frontal gyrus.The internal capsule and basal ganglia may also be affected.

The first reported case with FAS was published in 1907 by P. Marie [4]. Since then more than one hundred reports of this syndrome have been published [2]. Cases with FAS have been reported from various countries but in literature this is the first case report from Turkey and also the first known case where patient switches between multiple accents back- and-forth and keeps bringing in new accents over time. In order to clarify clinical variance and etiology of this rare case, speech-language pathologists should be consulted and advanced radiology imagings should be studied further.

[1] Whitaker, H.A., 1982. Levels of impairment in disorders of speech. and cognition 1,168-207. [2] Verhoeven, J., De Pauw, G., Pettinato, M., Hirson, A., Van Borsel, J., Mariën, P., 2003. Accent attribution in speakers with foreign accent syndrome, Journal of Communication Disorders 46-2, 156–168. [3] Scott, S. K., Clegg, F., Rudge, P., Burgess, P., 2006. Foreign accent syndrome, speech rhythm and the functional neuroanatomy of speech production, Journal of 19-5, 370–384. [4] Marie, P., 1907. Presentation de malades atteints d’anarthrie par lesion de l’hemisphere gauche du cerveau. Bull. Mem. Soc. Med. Hop. Paris 1, 158-160.