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A Case of Foreign Accent Syndrome Neurological Bulletin Volume 1 Issue 1 Article 4 2009-10-21 A Lilt of Finland in Worcester, Massachusetts: A Case of Foreign Accent Syndrome Richard P. Goddeau Jr. University of Massachusetts Medical School Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/neurol_bull Repository Citation Goddeau RP, Mitchell AL. A Lilt of Finland in Worcester, Massachusetts: A Case of Foreign Accent Syndrome. Neurological Bulletin 2009;1:14-16. https://doi.org/10.7191/neurol_bull.2009.1003. Retrieved from https://escholarship.umassmed.edu/neurol_bull/vol1/iss1/4 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Neurological Bulletin by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. Goddeau and Mitchell: Foreign Accent Syndrome Neurol. Bull. 1: 14-16, 2009 http://escholarship.umassmed.edu/neurol_bull doi:10.7191/neurol_bull.2009.1003 A Lilt of Finland in Worcester, Massachusetts: A Case of Foreign Accent Syndrome Richard P. Goddeau, Jr.* and Ann Mitchell Department of Neurology University of Massachusetts Medical School, Worcester, MA Foreign accent syndrome (FAS) is a rare Case Report speech output disorder characterized by artic- ulation of speech perceived by listeners A 57 year old previously healthy right- (often including the patient) as sounding handed man awoke with mild right arm and “foreign.” From Monrad-Krohn’s seminal facial weakness and a subjective sense of paper in 1947 1 describing a Norwegian mild confusion. He presented to the emer- woman who, as a result of head trauma, be- gency room at the University of Massachu- gan speaking with a German-sounding ac- setts Medical Center several hours later, after cent, several cases of FAS have been report- driving to work where colleagues observed ed. Usually occurring in consequence to that he was dysphasic, having expressive dif- some brain dysfunction, often stroke, two ficulty. During the initial evaluation, the distinct types of FAS are described: [1] ac- dysphasia resolved but the patient was noted quisition of an accent the patient was previ- to have dysprosodia, described by multiple ously unfamiliar with or unexposed to, the examiners and agreed by the patient as unlearned foreign accent, and [2] the rever- sounding like English spoken with a Finnish sion to a previously learned accent. In addi- accent. The patient, born and raised in Gard- tion to ischemic and hemorrhagic stroke,2-5 ner, Massachusetts, initially learned English traumatic brain injury,3,6 multiple sclerosis,7 and Finnish. His parents and several friends and the herald of primary progressive apha- were of Finnish extraction and he had visited sia8 have all been reported as causes of the Finland twice. He acquired fluency only in foreign accent syndrome. English, speaking with a “Massachusetts” accent. Here we report a case of reversion to a previ- ously learned foreign accent in a patient with On clinical examination, the patient was hy- acute ischemic stroke. We review data on pertensive at 229/77. Remaining vital signs anatomic localization in this subtype and were normal. General medical exam was how it informs on the nature of this unusual significant only for an irregularly irregular disorder. *Present Address: Dept. Neurology, Beth Israel Deaconess Hospital, Boston, MA Correspondence to Richard P. Goddeau, Jr.: [email protected] Keywords: foreign accent syndrome, left precentral gyrus 14 Goddeau and Mitchell: Foreign Accent Syndrome Neurol. Bull. 1: 14-16, 2009 doi:10.7191/neurol_bull.2009.1003 Figure 1: Noncontrast head CT with serial slices at and immediately cephalad to apex of body of the lateral ventricle showing hypodensity in left precentral gyrus. heart rhythm on auscultation. Neurologi- his accent regressed to his “normal” Massa- cally, the patient was alert and oriented. He chusetts accent. displayed a mild labial-type dysarthria and aprosodia in casual speech and singing and Discussion was assessed by multiple neurologists as having abnormal intonation, inflection and The dysprosodic features that characterize pauses for a native English speaker from FAS include aberrancies of word or sentence Massachusetts (see Audio file). Motor exam accentation, intonation, speech rate or showed normal strength testing but was sig- rhythm.9 In some reports, the acquired ac- nificant for a mild pronator drift of the right cent is discerned to represent a distinct ac- arm. Sensory, cerebellar and reflex exam cent of a non-native speaker, even when as- were unremarkable. sessed by native speakers of the area from where the accent would have been acquired Diagnostic evaluation included an electrocar- naturally.4 However, other reports have dis- diogram which revealed atrial fibrillation and closed dissenting opinions amongst listeners a noncontrast head CT scan (NCCT) show- as to “where” the accent would have origi- ing a small area of hypodensity in the left nated.6,8 In our patient, one listener thought precentral gyrus (Figure 1). Subsequent the accent sounded “Russian”; several others, brain MRI confirmed clinical and NCCT including the patient, believed it to be findings, showing two small areas of restrict- “Norwegian.” In any case, his speech rate ed diffusion in the left motor cortex and right was thought to be slowed, intonation flatter cerebellar hemisphere. Telemetry monitor- (than American or Massachusetts-dialect ing disclosed atrial fibrillation. English), with unexpected sentence accenta- tions. The patient was discharged on oral anticoag- ulation. Over the ensuing several weeks, The stroke lesion localization in the domi- 15 Goddeau and Mitchell: Foreign Accent Syndrome Neurol. Bull. 1: 14-16, 2009 doi:10.7191/neurol_bull.2009.1003 nant (left) precentral gyrus in our patient is 1947;70:405-415. consistent with prior reports. In the literature 2. Coughlan T, Lawson S, O'Neill D. review of Edwards and associates,3 7 of 22 French without tears? Foreign accent authors described a culprit lesion in the left syndrome. J R Soc Med 2004;97:242- motor cortex. Interestingly, all were cases of 243. unlearned FAS. Amongst previously learned 3. Edwards RJ, Patel NK, Pople IK. Foreign FAS, parietal and basal ganglia more than accent following brain injury: syndrome capsular lesions predominate;3,5 amongst un- or epiphenomenon? Eur Neurol learned FAS, left motor or pre-motor and 2005;53:87-91. parietal lesions predominate. However, basal 4. Hall DA, Anderson CA, Filley CM, ganglia, capsular, callosal, diffuse, and even Newcombe J, Hughes RL. A French ac- right-sided pre- and post-central gyrus le- cent after corpus callosum infarct. Neu- sions have been reported.2-4,6,7 rology 2003;60:1551-1552. 5. Roth EJ, Fink K, Cherney LR, Hall KD. Although most often transient, because FAS Reversion to a previously learned foreign occurs for weeks to months, it is thought to accent after stroke. Arch Phys Med Re- represent a discrete phenomenology, rather habil 1997;78:550-552. than an articulatory compensatory mecha- 6. Moonis M, Swearer JM, Blumstein SE, et nism for stroke (or other lesion) related dys- al. Foreign accent syndrome following a arthria. Furthermore, the speech in FAS is closed head injury: Perfusion deficit on not always dysarthric, dyspraxic, or dyspha- single photon emission tomography with sic. Yet, although several specific regions normal magnetic resonance imaging. have been repeatedly identified, there has Neuropsychiatry Neuropsychology and been no consensus lesion. Furthermore, Behavioral Neurology 1996;9:272-279. many patients with similar such lesions do 7. Bakker JI, Apeldoorn S, Metz LM. For- not display this speech patterning. A precise eign accent syndrome in a patient with neuroanatomic explanation may not be feasi- multiple sclerosis. Can J Neurol Sci ble. 2004;31:271-272. 8. Luzzi S, Viticchi G, Piccirilli M, et al. Physiologically, disruption of neuronal net- Foreign accent syndrome as the initial works for linguistic prosody or disinhibition sign of primary progressive aphasia. J of previously suppressed accent templates Neurol Neurosurg Psychiatry 2008;79:79 amongst a universal inventory of sounds has -81. been suggested.3,4,6 For previously learned 9. Verhoeven J, Marien P. Prosody and For- FAS, it is possible that bilingual or bi- eign Accent Syndrome: a Comparison of dialectical prosodic information is stored in Pre- and Post-stroke Speech (poster). discrete cortical areas, resulting in re- Presented at the Speech Prosody 2004 emergence of formerly suppressed speech International Conference; March 23-26, patterns with a lesion damaging the cortical 2004; Nara, Japan. area or pathways subserving the dominant speech patterns. Disclosure: the authors report no conflicts of interest. References All content in Neurological Bulletin, unless otherwise noted, is licensed under a Creative Commons 1. Monrad-Krohn GH. Dysprosody or al- Attribution-Noncommercial-Share Alike License http://creativecommons.org/licenses/by-nc-sa/3.0/ tered melody of language. Brain (ISSN 1942-4043) 16 .
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