Foreign Accent Syndrome Research Articles

Posterior Fossa Syndrome After Cerebellar Stroke

Posterior fossa syndrome (PFS) due to vascular etiology is rare in children and adults. To the best of our knowledge, PFS due to cerebellar stroke has only been reported in patients who also underwent surgical treatment of the underlying vascular cause. We report longitudinal clinical, neurocognitive and neuroradiological findings in a 71-year-old right-handed patient who developed PFS following a right cerebellar haemorrhage that was not surgically evacuated. During follow-up, functional neuroimaging was conducted by means of quantified Tc-99m-ECD SPECT studies. After a 10-day period of akinetic mutism, the clinical picture developed into cerebellar cognitive affective syndrome (CCAS) with reversion to a previously learnt accent, consistent with neurogenic foreign accent syndrome (FAS). No psychometric evidence for dementia was found. Quantified Tc-99m-ECD SPECT studies consistently disclosed perfusional deficits in the anatomoclinically suspected but structurally intact bilateral prefrontal brain regions. Since no surgical treatment of the cerebellar haematoma was performed, this case report is presumably the first description of pure, "non-surgical vascular PFS". In addition, reversion to a previously learnt accent which represents a subtype of FAS has never been reported after cerebellar damage. The combination of this unique constellation of poststroke neurobehavioural changes reflected on SPECT shows that the cerebellum is crucially implicated in the modulation of neurocognitive and affective processes. A decrease of excitatory impulses from the lesioned cerebellum to the structurally intact supratentorial network subserving cognitive, behavioural and affective processes constitutes the likely pathophysiological mechanism underlying PFS and CCAS in this patient.

A Case of Foreign Accent Syndrome

BackgroundForeign accent syndrome is a rare but potentially devastating clinical condition associated with altered speech rhythm and prosody, often occurring after a cerebral vascular accident. Missing this diagnosis can lead to delayed stroke work-up and treatment. ObjectiveWe report a case of foreign accent syndrome in a 60-year-old woman who presented to the Emergency Department (ED) with 3 weeks of altered speech pattern, widened gait, bilateral leg heaviness, and mild headache. Case ReportThe patient had a history of Type 2 diabetes, malignant hypertension, toxic nodular goiter, and hyperlipidemia. She initially presented to the ED at the onset of symptoms, was thought to have had speech change secondary to a goiter impinging on the recurrent laryngeal nerve, and was discharged. She returned to the ED 3 weeks later when outpatient imaging revealed subacute infarction of the left hemi-pons and absent flow within the left vertebral artery. On examination, the patient was alert and conversational. She spoke fluently with an accent that had components of Jamaican and the accent of an Italian speaking English. Neurology was consulted and the patient was admitted. The patient was treated medically, and was discharged home with primary care follow-up. She developed a second, more significant stroke 1 month later, with unilateral weakness and slurred speech in the middle cerebral artery distribution. ConclusionClinicians should be aware that some stroke patients present with various atypical symptoms, and should suspect stroke in any patient with acute-onset neurological symptoms, including speech change.

Accent attribution in speakers with Foreign Accent Syndrome

PurposeThe main aim of this experiment was to investigate the perception of Foreign Accent Syndrome in comparison to speakers with an authentic foreign accent. MethodThree groups of listeners attributed accents to conversational speech samples of 5 FAS speakers which were embedded amongst those of 5 speakers with a real foreign accent and 5 native speaker controls. The listening panels differed in their familiarity with foreign accented speech and speech pathology. ResultsThe findings indicate that listeners’ perceptual responses to the three groups of speakers were essentially different at all levels of analysis. The native speaker controls were unequivocally recognized as native speakers of Dutch while the speakers with a real foreign accent were very reliably assessed as non-native speakers. The speakers with Foreign Accent Syndrome, however, were in some sense perceived as foreign and in some sense as native by listeners, but not as foreign as speakers with a real foreign accent nor as native as real native speakers. These results are accounted for in terms of a misinterpretation of markers of speech pathology as markers regional affiliation. ConclusionsThe findings of the experiment are consistent with the idea that the very nature of the foreign accent is different in both groups of speakers, although it cannot be fully excluded that the foreign impression in the two groups is one of degree.Learning outcomes: Readers are able to: (1) define Foreign Accent Syndrome as a motor speech disorder and identify the different subtypes of FAS, (2) describe the most important differences in listeners’ perceptual reactions to FAS and real foreign accents, and (3) discuss the findings of the present study in relation to other studies investigating accent attribution in FAS.

Dissociative disorder presenting as foreign accent syndrome

Dissociative disorder presenting as foreign accent syndrome

Clinical foreign accent syndrome evolving into a multiplicity of accents

Abstract Foreign accent syndrome (FAS) is a speech disorder of abrupt onset in which the affected person's spoken output is altered such that it is perceived to have the quality of a foreign accent. FAS has most frequently been reported following stroke or trauma, but the diagnostic label has also been used to capture the clinical presentation of cases of suspected psychiatric origin. We describe here the case of a 37-year-old woman, DR, admitted to emergency for slurred speech, left-sided weakness, headache, and photosensitivity. On clinical grounds, her presentation was of sufficient concern to administer thrombolytic therapy. On day 9 of her admission DR began to speak with a French accent. Over the following months DR's speech alternated between at least five different accents, accompanied by associated behavioural changes. Neuropsychological evaluation and structural and functional magnetic resonance imaging studies conducted four months after her initial presentation revealed no evidence of disrupted language function or a likely causative lesion. This is, to our knowledge, the first description of FAS encompassing multiple distinct accents within a single individual. While the aetiology of DR's initial admission remains obscure, the course and features of her FAS over the following months are characteristic of disorders on the somatoform/factitious spectrum. This case highlights the limitations of a strict division between organic and functional disorders.

Acoustic and Perceptual Correlates of Foreign Accent Syndrome With Manic Etiology

In foreign accent syndrome (FAS), changes in articulation and prosody cause listeners to perceive the speaker as “foreign-sounding.” Fewer than 100 cases of FAS have been described in the literature; commonly associated with brain damage, only a handful of these have been analyzed with respect to acoustic measures. Acoustic and perceptual measurements were used to compare conversational samples of an individual with mania, first presenting with FAS and again after a return to baseline speech. Acoustic measurements included fundamental frequency, intensity, vowel space, and pause time. Perceptual measures were used to describe prosody, articulation, rate of speech, and intelligibility. Differences in acoustic and perceptual correlates and a negative impact on participation suggest the validity of assigning a diagnosis of FAS associated with mania despite lack of brain damage.

Foreign accent syndrome: A multimodal evaluation in the search of neuroscience-driven treatments

Foreign accent syndrome (FAS) is a rare condition which is placed in the mildest end of the spectrum of speech disorders. The impairment, not severe enough to elicit phonological errors, is associated with various alterations in the fine execution of speech sounds which cause the impression of foreignness. There is a growing interest in the study of linguistic and paralinguistic components, psychosocial aftermaths, and neural basis of FAS, but there are not yet neuroscience-driven treatments for this condition. A multimodal evaluation was conducted in a single patient with the aim of searching for clues which may assist to design neuroscience-driven therapies. The patient was a middle-aged bilingual woman who had chronic FAS. She had segmental deficits, abnormal production of linguistic and emotional prosody, impaired verbal communication, and reduced motivation and social engagement. Magnetic resonance imaging showed bilateral small lesions mainly affecting the left deep frontal operculum and dorsal anterior insula. Diffusion tensor tractography suggested disrupted left deep frontal operculum-anterior insula connectivity. Metabolic activity measured with positron emission tomography was primarily decreased in key components of networks implicated in planning and execution of speech production, cognitive control and emotional communication (Brodmann’s areas 4/6/9/10/13/25/47, basal ganglia, and anterior cerebellar vermis). Compensatory increases of metabolic activity were found in cortical areas (left anterior cingulate gyrus, left superior temporal gyrus and right prefrontal cortex) associated with feedback and focal attention processes critical for monitoring and adjustment of verbal utterances. Moreover, bilateral structural and functional abnormalities probably interrupted the trajectory of the lateral and medial cholinergic pathways causing region-specific hypoactivity. The results from this study provide targets for further investigation and some clues to design therapeutic interventions.

Two French-speaking cases of foreign accent syndrome: an acoustic–phonetic analysis

Foreign accent syndrome (FAS) is an acquired neurologic disorder in which an individual suddenly and unintentionally speaks with an accent which is perceived as being different from his/her usual accent. This study presents an acoustic–phonetic description of two Quebec French-speaking cases. The first speaker presents a perceived accent shift to Acadian French (French spoken in the easternmost provinces of Canada), whereas the second acquired an accent identified as Germanic. Speech seems affected by constraints on the coordination of articulatory gestures, expressed by distortions in the production of segments. These distortions do not necessarily result from changes in suprasegmental settings (slow speech rate and isochronous syllable pattern were observed) but may cause the disappearance of markers used for Quebec French accent recognition. Reported speech characteristics are comparable to those of speakers with apraxia of speech (AOS) but symptoms are relatively mild and somewhat similar to the speech of foreign speakers. For this reason, the position that FAS may be a mild form or subtype of AOS, as maintained by other authors, should be seriously considered.

Characterizing Intonation Deficit in Motor Speech Disorders: An Autosegmental–Metrical Analysis of Spontaneous Speech in Hypokinetic Dysarthria, Ataxic Dysarthria, and Foreign Accent Syndrome

The autosegmental-metrical (AM) framework represents an established methodology for intonational analysis in unimpaired speaker populations but has found little application in describing intonation in motor speech disorders (MSDs). This study compared the intonation patterns of unimpaired participants (CON) and those with Parkinson's disease (PD), ataxic dysarthria (AT), and foreign accent syndrome (FAS) to evaluate the approach's potential for distinguishing types of MSDs from each other and from unimpaired speech. Spontaneous speech from 8 PD, 8 AT, 4 FAS, and 10 CON speakers were analyzed in relation to inventory and prevalence of pitch patterns, accentuation, and phrasing. Acoustic-phonetic baseline measures (maximum-phonation-duration, speech rate, and F0-variability) were also performed. The analyses yielded differences between MSD and CON groups and between the clinical groups in regard to prevalence, accentuation, and phrasing. AT and FAS speakers used more rising and high pitch accents than PD and CON speakers. The AT group used the highest number of pitch accents per phrase, and all 3 MSD groups produced significantly shorter phrases than the CON group. The study succeeded in differentiating MSDs on the basis of intonational performances by using the AM approach, thus, demonstrating its potential for charting intonational profiles in clinical populations.

Poster 36 Development of Foreign Accent Syndrome Following Mild Traumatic Brain Injury: A Case Report

PM&RVolume 4, Issue 10S p. S202-S202 2012 AAPM&R Annual Assembly Abstract Poster 36 Development of Foreign Accent Syndrome Following Mild Traumatic Brain Injury: A Case Report Kelly M. Crawford MD, Kelly M. Crawford MD University of Cincinnati, Cincinnati, OH, United StatesSearch for more papers by this authorSheital Bavishi DO, Sheital Bavishi DO University of Cincinnati, Cincinnati, OH, United StatesSearch for more papers by this author Kelly M. Crawford MD, Kelly M. Crawford MD University of Cincinnati, Cincinnati, OH, United StatesSearch for more papers by this authorSheital Bavishi DO, Sheital Bavishi DO University of Cincinnati, Cincinnati, OH, United StatesSearch for more papers by this author First published: 23 October 2012 https://doi.org/10.1016/j.pmrj.2012.09.666Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume4, Issue10SOctober 2012Pages S202-S202 RelatedInformation

Phonological and phonetic marking of information status in Foreign Accent Syndrome

Foreign Accent Syndrome (FAS) is a motor speech disorder in which a variety of segmental and suprasegmental errors lead to the perception of a new accent in speech. Whilst changes in intonation have been identified to contribute considerably to the perceived alteration in accent, research has rarely focused on how these changes impact on the pragmatic use of intonation. However, a greater understanding of the role of intonational changes in FAS and its impact on the functional use of intonation is fundamental to developing appropriate assessment and subsequently treatment strategies for FAS. This study investigated intonation patterns in speakers with FAS and matched control participants with regard to their ability to signal new and given information (information status) within sentences. A phonetic and phonological perspective was taken with the aim of identifying the characteristics that were compromised in FAS to convey this linguistic function. Four speakers with FAS and four control participants participated in the speech production experiment. The speech data were assessed perceptually, and examined in relation to the use of the phonetic parameters fundamental frequency (f0), intensity and duration as well as phonological categories, i.e. pitch accents and de-accentuation, using the autosegmental-metrical (AM) framework of intonational analysis. Both speaker groups employed all three phonetic parameters to differentiate between new and given information. However, groups differed regarding the use of phonological markers, with speakers with FAS frequently placing pitch accents on given information instead of de-accenting these elements. According to the perceptual evaluation, three of the four speakers with FAS had problems signalling information status. The fact that speakers with FAS marked information status similarly to control speakers at the phonetic level, but failed to do so using phonological categories highlights the importance of assessing phonetic as well as phonological features to gain detailed information about the functional use of intonation in FAS.

A Transient Loss of British Charm: A Case of Foreign Accent Syndrome and Proposed Neuroanatomical Pathway (P02.050)

A Transient Loss of British Charm: A Case of Foreign Accent Syndrome and Proposed Neuroanatomical Pathway (P02.050)

P-186 - Mania-induced foreign accent syndrome: a case study

Foreign accent syndrome (FAS) is a rare condition involving speech output that usually occurs subsequent to cerebrovascular injury. Articulatory distortions of the native language are perceived as foreign/dialectical by others of the region. This report considers a case of FAS during two distinct periods of mania without evidence of cerebrovascular injury. The case provides a detailed explanation of the patient's history, course, speech and neuropsychological testing patterns. To describe in the literature the first case of mania-induced FAS. This case study was detailed retrospectively, providing a thorough psychiatric and medical history, formal neuropsychological testing, and speech analysis of baseline and exacerbation periods via voice recordings. The patient displayed two distinct episodes of FAS only present during mania. Due to signs of limited effort, as well as potential effects of anxiety on performance, neuropsychological testing reflected inconsistent findings irreconcilable with any particular diagnostic pattern. Speech samples from both exacerbation and recovery periods parsed for comparison showed excess-equal stress, and consonant-vowel distortions when symptomatic. Elevated fundamental frequency, higher intensity, decreased speech intelligibility, and faster rate of speech were produced during exacerbation. No significant medical abnormalities were revealed by laboratory, CT scan or physical exam results. As the patient had no history of cardiovascular or cerebrovascular disease, negative medical workup, negative brain imaging, and neuropsychological testing failing to demonstrate an etiology for the FAS exacerbation, we conclude the patient's FAS was a result of mania. Speech analysis also supported this theory.

Intonation in neurogenic foreign accent syndrome

Foreign accent syndrome (FAS) is a motor speech disorder in which changes to segmental as well as suprasegmental aspects lead to the perception of a foreign accent in speech. This paper focuses on one suprasegmental aspect, namely that of intonation. It provides an in-depth analysis of the intonation system of four speakers with FAS with the aim of establishing the intonational changes that have taken place as well as their underlying origin. Using the autosegmental-metrical framework of intonational analysis, four different levels of intonation, i.e., inventory, distribution, realisation and function, were examined in short sentences. Results revealed that the speakers with FAS had the same structural inventory at their disposal as the control speakers, but that they differed from the latter in relation to the distribution, implementation and functional use of their inventory. The current results suggest that these intonational changes cannot be entirely attributed to an underlying intonation deficit but reflect secondary manifestations of physiological constraints affecting speech support systems and compensatory strategies. These findings have implications for the debate surrounding intonational deficits in FAS, advocating a reconsideration of current assumptions regarding the underlying nature of intonation impairment in FAS. Learning outcomes: The reader will be able to (1) explain the relevance of intonation in defining foreign accent syndrome; (2) describe the process of intonation analysis within the autosegmental-metrical (AM) framework; and (3) discuss the manifestation of intonation changes in FAS at the different levels of intonation and their potential underlying nature.

Foreign accent syndrome: A multimodal mapping study

The present study explored the functional neuroanatomy of Foreign Accent Syndrome (FAS) in an Italian native speaker who developed an altered speech rhythm and melody following a circumscribed tumour to the left precentral gyrus. Structural, functional, fibre tracking and intraoperative findings were combined. No signs of dysarthria, apraxia of speech, or aphasia nor other cognitive deficits were detected, except for the fact that the patient was perceived as a non-native speaker. The patient fMRI maps were compared with a control group of 12 healthy controls. During counting, sentences and pseudoword pronunciation the patient showed an additional increased sparse activation in areas around the pre/postcentral gyrus corresponding to those involved in phonation (i.e., larynx motor area). The intraoperative cortical stimulation mapping evidenced a mouth motor representation close to the tumour, a motor type of speech arrest site just below it, and anteriorly a proper speech arrest site. Our results are discussed within the current neurolinguistic models of speech production, and emphasize the importance of the primary motor cortex. We argue that this FAS case should be thought of as a disorder of the feedforward control commands, in particular of the articulator velocity and position maps which are hypothesized to lie along the caudoventral portion of the precentral gyrus.

Neural bases of the foreign accent syndrome: A functional magnetic resonance imaging case study

Foreign accent syndrome (FAS) is a rare disorder characterized by the emergence of a perceived foreign accent following brain damage. Despite decades of study, little is known about the neural substrates involved in this disorder. In this case study, MRI images of the brain were obtained during a speech task for an American English-speaking monolingual female who presented with FAS of unknown etiology and was thought to sound ‘Swedish’ or ‘Eastern European’. On the basis of MR structural imaging, the patient was noted to have frontal lobe atrophy. An fMRI picture-naming task designed to broadly engage the speech motor network revealed predominantly left-hemisphere involvement, including activation of the (1) left superior temporal and medial frontal structures, (2) bilateral subcortical structures and thalamus, and (3) left cerebellum. The results suggest an instance of substantial brain reorganization for speech motor control.

Foreign accent syndrome caused by a left temporal-parietal ischaemic stroke.

Karanasios P, Loukopoulou P, Zampakis P, Tiligadas T, Makridou A, Doukas V, Argyriou AA. Foreign accent syndrome caused by a left temporal-parietal ischaemic stroke. We present the first reported case of a Greek patient with foreign accent syndrome (FAS) secondary to a left temporal-parietal ischemic stroke. A 76 year-old right-handed, Greek in origin, male was referred because he had suddenly manifested changes in speech expression. The neurological examination revealed that his prior typical English-Australian accent resembled a mixture of Greek and English-Britain accent consistent with FAS, though he had visited only once Greece the last 15 years and never had been to United Kingdom. A brain Magnetic Resonance Imaging scan depicted an ischemic temporal lesion in the language-dominant left hemisphere, affecting the left posterior superior and middle temporal gyri, as well as the ipsilateral inferior supramarginal angular gyrus and posterior insula. We might suggest that FAS in our patient was induced because of interrupted cortical-subcortical feedback pathways. The phenomenon of subcortical-cortical diaschisis might also have contributed to its clinical manifestation.

Living with foreign accent syndrome: Insider perspectives

Background: Foreign accent syndrome (FAS) represents an acquired neurological speech disorder where an individual suddenly appears to be involuntarily speaking with an accent they have never used before. Numerous studies have sought to uncover the underlying neurological, psycholinguistic, and acoustic correlates of this. No studies have examined FAS from the perspective of the speaker. Aims: We aimed to investigate and characterise the experience of living with FAS. Methods & Procedures: We conducted in-depth semi-structured interviews with 13 people with neurogenic FAS in their own homes. Interviews were transcribed verbatim. We employed Framework Analysis (Ritchie & Lewis 2003) and iterative feedback to participants to identify and confirm common emerging themes. Results & Outcomes: Four main themes emerged linked to (i) factors associated with the underlying neurological condition that could have a bearing on experiences and reactions independent of the FAS; (ii) altered accent: sense of self; (iii) altered accent: reactions of others. A fourth theme, coping strategies and adaptation, contained elements spanning the three others. Accounts highlighted negative aspects of FAS that individuals had to struggle to overcome. Positive outcomes were also identified. All participants stressed that the experience of FAS entailed a journey into unknown territory. Even if the journey's end was a return of the former accent, a new sense of self persisted as a result of the FAS experience. Conclusions: People with FAS are exposed to issues and adjustments shared with people with neurological conditions in general and speech disorders in particular. They experience the personal and interactional issues associated with being a stranger within a community with a different accent. An understanding of FAS requires attention to all these planes. We argue that the true essence of the experience of FAS lies in the unique intersection of these dimensions, and this determines the personal journeys of people with FAS.

左前頭葉梗塞で foreign accent syndrome を呈した矯正右利きの一例

発症最初期にみられた anarthria による不規則な構音の歪みや置換の改善とともに，運動障害性構音障害や他の失語症状を伴わない純粋な foreign accent syndrome (FAS) を呈し，その後症状がほぼ消失した症例を報告した。症例は 47 歳，矯正右利きで，中枢性右顔面麻痺を伴う右片麻痺と呂律困難で発症した。頭部 MRI では中心前回中・下部を含む左前頭葉に梗塞を認めた。発症 5 日時点で見られた発話における音の不規則な歪み，置換や語頭音の繰り返しは発症 2 週後までに軽減，消失し，その一方で，自発話や単語，短文の音読，復唱時に prosody 障害が目立つようになった。すなわち，単語内のアクセントの移動や 1 単語における 2 単位のアクセントなどが頻発し，発話速度の増加もみられた。これらの特徴は患者の発話の聞き手に外国人様という印象を抱かせた。この prosody 障害は発症 7 ヵ月までに軽減，消失した。本症例の prosody 障害は，anarthria に随伴する prosody の平板化と発話速度の減少を主体とするタイプとも，右半球損傷でみられる感情表現の prosody 障害を主体とするタイプとも異なっており，平板化とは逆方向の prosody 障害や，発話速度の性急さなどの特徴から FAS と考えられた。

Perception of foreign accent syndrome speech and its relation to segmental characteristics

Foreign accent syndrome (FAS) is an acquired neurogenic disorder characterized by altered speech that sounds foreign-accented. This study presents a British subject perceived to speak with an Italian (or Greek) accent after a brainstem (pontine) stroke. Native English listeners rated the strength of foreign accent and impairment they perceived in speech of the FAS subject, alongside that of two native English speakers and Italian, Greek, and French L2 speakers acting as controls. The FAS subject was perceived to be as foreign-sounding as the L2 control speakers, but was also perceived as mildly impaired. The FAS subject's own perception of accents was also explored and it was found that his ability to distinguish presence and absence of accent does not seem to be affected. The relationship between listeners' perceptions and features of the FAS speech is explored via correlational statistics and qualitative analysis. Impressionistic phonetic analysis, supplemented by acoustic analysis, confirmed a number of features consistent with a typical Italian (and also Greek) accent and the Italian and Greek L2 speakers. A pre-stroke and a post-stroke sample from the FAS subject were compared and the nature of post-stroke changes in segmental realizations is discussed.