Abstract

Multiple reports have described patients with disordered articulation and prosody, often following acute aphasia, dysarthria, or apraxia of speech, which results in the perception by listeners of a foreign-like accent. These features led to the term foreign accent syndrome (FAS), a speech disorder with perceptual features that suggest an indistinct, non-native speaking accent. Also correctly known as psuedoforeign accent, the speech does not typically match a specific foreign accent, but is rather a constellation of speech features that result in the perception of a foreign accent by listeners. The primary etiologies of FAS are cerebrovascular accidents or traumatic brain injuries which affect cortical and subcortical regions critical to expressive speech and language production. Far fewer cases of FAS associated with psychiatric conditions have been reported. We will present the clinical history, neurological examination, neuropsychological assessment, cognitive-behavioral and biofeedback assessments, and motor speech examination of a patient with FAS without a known vascular, traumatic, or infectious precipitant. Repeated multidisciplinary examinations of this patient provided convergent evidence in support of FAS secondary to conversion disorder. We discuss these findings and their implications for evaluation and treatment of rare neurological and psychiatric conditions.

Highlights

  • Foreign accent syndrome (FAS) is a rarely encountered speech disorder that presents with abnormalities in articulation and prosody which are perceived by listeners as sounding similar to a foreign accent

  • FAS has been associated with a variety of neurological illnesses, including multiple sclerosis [19,20], primary progressive aphasia [21], cerebellar hypoperfusion [22], and metastatic breast cancer [23]

  • We present a case of FAS secondary to conversion disorder based on multidisciplinary assessment and treatment

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Summary

Introduction

Foreign accent syndrome (FAS) is a rarely encountered speech disorder that presents with abnormalities in articulation and prosody which are perceived by listeners as sounding similar to a foreign accent. FAS is most commonly associated with lefthemisphere lesions [1] secondary to CVA [2,3,4,5,6,7,8,9,10,11,12,13] and traumatic brain injury (TBI) [14,15,16,17]. Several case reports of patients with FAS and psychiatric illness without a known brain lesion have appeared, including patients with bipolar disease [24], psychosis [25,26], psychogenic illness [27], and conversion disorder [28,29]. We describe the multidisciplinary assessment and diagnosis of FAS secondary to conversion disorder

Patient description
Neurological examination
Neuropsychological assessment
Cognitive-behavioral and biofeedback assessment
Motor speech examination
Larynx
Velopharynx
Orofacial mechanism
Prosody
Speech assessment
Medical therapy
Pain management intervention
Speech therapy
Findings
Discussion
Full Text
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