I wish I could sound French!

When we learn a foreign language as adults we discover that producing spoken language is a complicated affair. Learning vocabulary and grammar may not be difficult. But trying to sound like a native speaker can be quite a feat. Individual speech sounds challenge us and producing long and phonologically complicated words at a normal speaking rate can prove impossible. And then there is the intonation! You feel like you will never get it right and the dream of speaking French or Italian like a native becomes an unrealistic goal.
So how would you feel if you suddenly started speaking your native tongue like a foreigner? This peculiar and rare syndrome, foreign accent syndrome (FAS), was first described in the early 20th century and is one of the neurological syndromes which regularly finds its way into the media. And blogs such as this one!

Foreign accent syndrome
A very small insult to the brain is sufficient to disturb the processes that control the delicate articulatory planning and coordination necessary for producing speech sounds correctly. This can happen, for example, when there is a small stroke, typically in the front part of the left hemisphere. This results in people sounding like foreigners when speaking their native tongue, hence the term foreign accent syndrome (FAS). However, FAS really is a misnomer. The term indicates that a person has somehow acquired a new accent whereas the fact is that the speaker has lost the ability to articulate his mother tongue correctly. It is the listener´s familiarity with other languages that influences whether the accent is interpreted as a German, Irish or French. One could thus say that FAS is in the ear of the beholder and the syndrome has therefore also been termed “pseudo-accent” because it is not a “true” accent.
It has been suggested that FAS can, in some cases, have psychological causes. This was not the reason in the following case although the patient´s symptoms were at first thought to be psychological in nature, or psychogenic.



Case description
A 37 year-old woman suddenly lost the ability to speak her native tongue, Icelandic, and was also unable to write. She comprehended spoken language and could read. She had no paralysis or weakness in the body. The following day she had improved but still spoke with abnormal rhythm and intonation and her speech was poorly articulated and slow. A physician she saw reportedly told her she sounded like the wife of the Russian ambassador to Iceland! To others she sounded German. She was admitted to a neurological rehabilitation hospital for further evaluation and speech therapy. By that time her speech was more fluent but still sounded foreign. She could produce individual speech sounds quite normally. Combining them in a continuous correctly sounding speech stream was, however, problematic. A neuropsychological evaluation conducted at the rehabilitation unit by me was almost entirely normal. She had no problems with verbal and non-verbal memory, visuo-perceptual abilities and logical reasoning and only very slight problems retrieving names for things (this is called anomia). I told her that her peculiar speaking pattern had a name, foreign accent syndrome, and explained its nature to her. This was a big relief to the patient as others had not been able to explain her symptoms and had even suggested that they were psychological. The physicians treating her at the emergency room were unfamiliar with FAS which is not surprising given its rarity. A computed tomography (CT) of the brain in the emergency room also showed no abnormalities. A more sensitive investigation of the brain (MRI scan) at the rehabilitation hospital revealed a very small infarct in the pre-central cortex of the left hemisphere (see picture). An infarct is a type of stroke, which is due to blockage of a vessel in the brain. With time the patient improved quite well but those of us familiar with her history could still hear the remnants of her “Russian” accent a year later.

Foreign accent syndrome is a rare disorder and most clinicians will not encounter this syndrome during their career. Many do not know that a stroke or brain injury can have this consequence.
An excellent report on FAS can be found on National Public Radio: http://www.npr.org/blogs/health/2011/06/01/136824428/a-curious-case-of-foreign-accent-syndrome#commentBlock

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