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Objective: This case study aims to present the Foreign Accent Syndrome (FAS) in a patient with Cerebral Arteriovenous Malformation (cAVM), considering neuropsychological, radiological and microsurgical aspects. Methods: The patient underwent preoperative neuropsychological assessment and MRI and Tractography were performed to identify fibers close to the lesion site. In the surgical procedure, a craniotomy was performed for excision of the cAVM. After surgery and 6 months after the surgical procedure, the patient underwent further and neuropsychological evaluations. Results: The presence of AVM located in the posterior part of the medial surface of the left superior frontal gyrus was identified and the neuropsychological evaluation found cognitive deficits and symptoms characteristic of FAS, which disappeared after resection. Conclusion: This report presented a case of cAVM in which symptoms were found even without rupture, which was no longer observed after the surgical procedure, demonstrating the relationship of cAVM with the symptoms and neuroanatomical bases of FAS. [ABSTRACT FROM AUTHOR]

Sociolinguistic factors such as status and prestige can significantly impact the persistence of an accent in a patient with Foreign Accent Syndrome (FAS). FAS is a rare acquired syndrome that affects a speaker's accent typically caused by a stroke or trauma. In this presented FAS case study, we explore two distinct perspectives on a shift from a Sicilian to a North-East variety of Italian accent, caused by an accident trauma. Data have been collected with an ethnographic approach to explore the patient's narrative towards his 'foreign accent'. Firstly, the study analyzes the perception of native listeners through a speech sample perception test of different varieties of Italian. The listeners' responses revealed a diversified classification of the accent, highlighting the listener's crucial role in assigning the status of 'foreignness' to a particular variety. Additionally, an analysis with Praat software showed that the FAS speaker used a variety with some Sicilian and North-East traits. Secondly, the study investigated the patient's perception of their new accent through an ethnographic approach and participant observer technique. The results revealed a typology of FAS speakers that correlated with sociolinguistic factors not previously identified by research. In conclusion, this study sheds light on the complex interplay between sociolinguistic factors and FAS, demonstrating the importance of exploring FAS under various perspectives of research. [ABSTRACT FROM AUTHOR]

Purpose: When nonnative speaking patterns emerge following neurologic insult or injury, it has often been referred to as foreign, or nonnative, accent syndrome (FAS). In many other cases, FAS can occur as a manifestation of a functional speech disorder (FSD). The purpose of this clinical focus article is to (a) describe the methods utilized in identifying and managing a functional communication disorder characterized by nonnative speech, language, and nonverbal communication intrusions, accompanied by a functional movement disorder and (b) describe the patient's lived experience. Method and Results: The patient is a 59-year-old monolingual English-speaking gentleman with a remote history of episodic stuttering, who later developed an abrupt onset of a nonnative speaking style that changed in quality over time. He also developed gait difficulties that, after visiting with several neurologists, were judged to reflect a functional neurological disorder. During the speech evaluation session, an "Eastern European accent" was noted, along with nonnative word use and word order. A diagnosis of FSD characterized by foreign accent was made, and intervention was undertaken as detailed in the clinical focus article and demonstrated in the accompanying video. With behavioral intervention, the patient was able to correct sound-level changes in structured tasks such as reading and repetition and then in conversation. Language dialect--like changes resolved without direct intervention. The nonspeech movement disorder was addressed with intensive occupational and physical therapy. Conclusions: The patient presented with functional FAS, which was effectively managed with symptomatic, targeted behavioral intervention. His experience demonstrates the importance of patient advocacy in acquiring an accurate diagnosis and appropriate management recommendations. [ABSTRACT FROM AUTHOR]

Background: Stroke is the second leading cause of death in the world and is the leading cause of disability worldwide. One of the disabilities is language disorder. Foreign Accent Syndrome (FAS) is a clinical condition associated with a noticeable change of accent, that could affect verbal communication and social interaction skills. By identifying this case earlier, we hope that the patient's activity daily living is less disrupted. Case: A 54-year-old woman came with complaints of weakness and tingling in the right limbs accompanied by a change in language accent. Weakness in the right limbs was felt since 4 years ago, then 1 year later the patient began to experience a change in the speech accent, from a Javanese accent to a Madurese accent, where previously the patient had never lived or studied Madurese. The results of the neurobehavior examination showed that the patient had disturbances in the language and memory domain. MRI revealed cerebral infarction in the hippocampi bilateral, small vessel ischemic in the frontal lobes bilateral and corona radiata bilateral. Discussion: The accent change, known as FAS that was experienced by the patients are thought to be due to neurological causes, which was stoke. In a study using a lesion network mapping approach concluded that the lesion causing accent disorder was located within a single network in the bilateral frontal lobe. In line with the existing theory, the MRI results in this patient showed ischemia in the blood vessels of the bilateral frontal lobes. [ABSTRACT FROM AUTHOR]

Foreign accent syndrome (FAS) is characterized by new onset speech that is perceived as foreign. Available data from acquired cases suggests focal brain damage in language and sensorimotor brain networks, but little remains known about abnormal functional connectivity in idiopathic cases of FAS without structural damage. Here, connectomic analyses were completed on three patients with idiopathic FAS to investigate unique functional connectivity abnormalities underlying accent change for the first time. Machine learning (ML)-based algorithms generated personalized brain connectomes based on a validated parcellation scheme from the Human Connectome Project (HCP). Diffusion tractography was performed on each patient to rule out structural fiber damage to the language system. Resting-state-fMRI was assessed with ML-based software to examine functional connectivity between individual parcellations within language and sensorimotor networks and subcortical structures. Functional connectivity matrices were created and compared against a dataset of 200 healthy subjects to identify abnormally connected parcellations. Three female patients (28–42 years) who presented with accent changes from Australian English to Irish (n = 2) or American English to British English (n = 1) demonstrated fully intact language system structural connectivity. All patients demonstrated functional connectivity anomalies within language and sensorimotor networks in numerous left frontal regions and between subcortical structures in one patient. Few commonalities in functional connectivity anomalies were identified between all three patients, specifically 3 internal-network parcellation pairs. No common inter-network functional connectivity anomalies were identified between all patients. The current study demonstrates specific language, and sensorimotor functional connectivity abnormalities can exist and be quantitatively shown in the absence of structural damage for future study. [ABSTRACT FROM AUTHOR]

This timely collection is an international effort to serve as a foundation to encourage research that offers insights into the interaction between language variation and motor speech disorders. Specifically, this forum aimed to provide a platform that (a) explores and demonstrates the role of language variation in the manifestation of dysarthria, (b) considers language variation in clinical assessment and management, and (c) promotes awareness of diverse language backgrounds of people with dysarthria. The forum contains six articles, spanning a variety of research designs (cross-sectional, pre- and post-treatment), kinds of articles (tutorial, research article, commentary), and a range of languages from around the world (English, French, Korean Portuguese, Spanish). [ABSTRACT FROM AUTHOR]

Foreign accent syndrome (FAS) is an extremely rare disorder characterized by the appearance of speech changes that are perceived by the speaker and listeners as an acquired foreign accent. It still remains a poorly understood condition. Three main types of FAS have been reported in the medical literature as neurogenic, psychogenic, and mixed type. Psychogenic FAS includes all cases of FAS in which an organic cause has not been identified and a clear psychological factor has been identified after careful clinical, neurological, and neuroradiological examination. Although the COVID-19 epidemic, which has been ongoing since February 2020, primarily manifests itself with upper respiratory tract infection findings, it is seen that it also causes a wide range of neurological and psychiatric signs and symptoms. In this study, a 42-year-old female patient who started to have speech disorder after COVID-19 infection is presented in the light of clinical history, diagnosis, and differential diagnosis literature findings. [ABSTRACT FROM AUTHOR]

We describe a previously fit and well 54-year-old female who acquired a range of severe and persisting neuropsychological impairments following a posterior reversible encephalopathy syndrome (PRES) complication of COVID-19. The initial presentation included aphasia, a neurogenic foreign accent syndrome (FAS) and a persisting complete cortical blindness from the underpinning parieto-occipital brain injury. Neuropsychological single clinical case report. The patient retained insight and made good early progress with their adjustment to the numerous losses caused by the COVID-19 associated acquired brain injury. Comprehensive neuropsychological investigation characterised an acalculia, along with deficits in focused, sustained and divided attention impacting on verbal memory, working memory and executive functioning, amongst numerous relative strengths. Similar to PRES from other aetiologies, COVID-19 associated PRES can in some cases cause irreversible acquired brain injury. The diverse neuropsychological effects need to be comprehensively investigated and managed. This case adds to the neuropsychological literature on PRES, FAS and acquired brain injury as a rare complication of SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Yale law professor Amy Chua once asked, "do you know what a foreign accent is? It's a sign of bravery." As an immigrant with a foreign accent, I find this quote thought‐provoking and interesting to consider. [ABSTRACT FROM AUTHOR]

Suprasegmental features are often affected by brain damage, and are typically accompanied by motor speech disorders such as dysarthria, apraxia of speech (AOS), and foreign accent syndrome (FAS). However, there is no report of a selective pitch accent disorder without motor speech impairments or FAS. We describe a female Japanese patient who developed a selective pitch accent disorder without motor speech impairments or FAS, with accompanying mild Wernicke's aphasia due to head injury, in order to investigate the mechanism of pitch accent disorder based on speech production models. We analysed her spontaneous speech, confrontation naming, repetition, reading aloud, and the error patterns in her pitch accents in two sessions. Additionally, we gave her a reading aloud test of homonyms with different accent patterns and an auditory discrimination task of pitch accents. The patient exhibited a significant recovery from aphasia, and paraphasia was observed to almost disappear, although the pitch accent errors remained in all speech modalities. While she was able to auditorily distinguish between correct and incorrect pitch accents, she was unaware of her own abnormally accented speech. The results of the analysis of the error patterns in her pitch accents revealed that they, even if incorrect for the selected words, did not actually deviate from the correct patterns in the Osaka dialect, her native dialect. Our observations suggest that the process of pitch accent production may be independent of that of phoneme production. Moreover, it may be that her accent abnormalities were not produced randomly during the process of articulation, but instead may have been due to a problem in selecting pitch accent patterns from the repertoire of Osaka accent patterns allocated to the corresponding words. This suggests that the patient's pitch accent disorder was a problem in a higher level of linguistic processing, i.e., lexical pitch accent encoding, rather than the motor control of speech production. [ABSTRACT FROM AUTHOR]

This article describes a case of Foreign accent syndrome (FAS) in an Italian woman who developed a Canadian-like foreign accent without brain damage (functional FAS). The patient underwent an in-depth neuroimaging and (neuro)psychological evaluation. Language networks in the frontotemporal-parietal areas were typically activated bilaterally through fMRI and MEG assessments based on task-based data. Resting-state fMRI showed preserved connectivity between language areas. An obsessive-compulsive personality profile and mild anxiety were found, suggesting psychological and psychiatric factors may be relevant. Accordingly with our findings, multimodal imaging is beneficial to understand FAS neurological and functional etiologies. [ABSTRACT FROM AUTHOR]

It is surprising when a patient's care-taker informed the doctor that their family member could suddenly speak in a different accent. Here we reported a case of a young female with infective endocarditis (IE), who later developed a foreign accent syndrome during her stay in the hospital ward. A plain computed tomography (CT) scan of the brain was performed and it showed a coarse and irregular calcific lesion in the left frontal region. Her condition deteriorated rapidly the next day and she died of intracranial haemorrhage. The haemorrhage was possibly caused by a ruptured mycotic aneurysm, a known complication of IE. [ABSTRACT FROM AUTHOR]

Abstract Foreign Accent Syndrome (FAS) is a rare clinical entity in which affected patients experience a new pattern of speech resembling an unusual accent. Reported cases are scarce in published literature and are usually the result of a neurological insult. FAS as a complication from a general anesthetic or surgery has not been reported to date. We present the case of a healthy 27‐year‐old Australian woman who developed FAS following a tonsillectomy. Post operatively, speech patterns resembled an Irish accent. We discuss the potential mechanisms of the unusual complication as well as review the available literature surrounding FAS.

One of the consequences of a stroke inhumanis a foreign accentual syndrome, which is often caused by trauma or stroke. One of the most important injuries in this syndrome is a disruption in prosodic units. The present report is about a 47-year-old woman with a brain tumorwhospeaks with a different accent than hers. Acoustic analyses were performed using the Praat software version 6.0.35. This paper indicates consistency with most of the damage reports in prosodic units, including stress, rhythm, pause, and speed of speech. Significant changes occurred in the prosodic units of the patient under study within 12 weeks. In addition to the decrease in the number of pauses and speech duration of the patient, pitch variations, increased coordination, and precision in articulation, also an increase in the expression of the number of words was observed during the patient's speech. Due to the rarity of foreign accent syndrome, further research in this area is important for speech and language pathologists in terms of differential diagnosis and speech therapy. [ABSTRACT FROM AUTHOR]

Emotive speech is a non-invasive and cost-effective biomarker in a wide spectrum of neurological disorders with computational systems built to automate the diagnosis. In order to explore the possibilities for the automation of a routine speech analysis in the presence of hard to learn pathology patterns, we propose a framework to assess the level of competence in paralinguistic communication. Initially, the assessment relies on a perceptual experiment completed by human listeners, and a model called the Aggregated Ear has been proposed that draws a conclusion about the level of competence demonstrated by the patient. Then, the automation of the Aggregated Ear has been undertaken and resulted in a computational model that summarizes the portfolio of speech evidence on the patient. The summarizing system has a classical emotion recognition system as its central component. The code and the data are available from the corresponding author on request. [ABSTRACT FROM AUTHOR]

Introduction. Foreign Accent Syndrome (FAS) is a rare entity. Patients develop changes in rhythm and tone of speech (prosody), perceived as a different accent than their native language. There are three types of FAS: neurogenic, psychogenic and mixed. FAS is rare in ms, and even more so as a first manifestation. Objective. Review of FAS, types, pathophysiology, presentation in ms and evolution. Summary. Cortical lesions in ms are correlated with cognitive impairment, motor disability, psychiatric symptoms, language 3 disorders, speech impairment, and seizures. Most of the published cases of fas have suffered injury in the dominant hemisphere, in the prerrolandic cortex and adjacent areas, frontal motor association areas, in the putamen, basal ganglia, and theposterior fossa (protuberance, cerebellum). Different etiologieshave been reported, vascular being the most frequent. We present the case of a 44-year-old woman who first manifestation was fas, previously interpreted as a brain ischemia and finally diagnosed as multiple sclerosis. This case had partial improvement of the symptoms after phonoaudiologic rehabilitation. Conclusions. FAS is rarely observed as an initial presentation of MS debut, as cortical symptoms are atypical relapses. An inflammatory demyelinating cause should be considered in young patients lacking vascular risk factors, and must be supported by complementary neuroimaging studies. [ABSTRACT FROM AUTHOR]

Foreign Accent Syndrome (FAS) is a rare clinical entity in which affected patients experience a new pattern of speech resembling an unusual accent. Reported cases are scarce in published literature and are usually the result of a neurological insult. FAS as a complication from a general anesthetic or surgery has not been reported to date. We present the case of a healthy 27‐year‐old Australian woman who developed FAS following a tonsillectomy. Post operatively, speech patterns resembled an Irish accent. We discuss the potential mechanisms of the unusual complication as well as review the available literature surrounding FAS. Foreign accent syndrome (FAS), is a rare clinical entity, which has not been reported in literature to date as a post‐operative complication. We discuss the potential mechanisms of this unusual complication. [ABSTRACT FROM AUTHOR]

Introduction: Foreign accent syndrome (FAS) is a rare speech disorder. It is becoming increasingly common to find reports of cases about alterations different from the suprasegmental aspects of speech, although these reports are not frequent in Spanish-speaking patients. Case presentation: 48-year-old female patient from Colombia diagnosed with FAS, segmental and suprasegmental speech alterations, and changes in cognitive domains (executive functions and language). The woman also presented with motor and affective changes. Brain imaging studies ruled out structural involvement and follow-up at one year did not show significant changes in speech. Discussion: This case presents the neurological, neuropsychological and speech features of a Spanish-speaking patient with FAS. Greater alteration in vowels than in consonants, alteration in pronunciation time, variation in rhythm and intonation of words and phrases, decrease of time between syllables, and insertion of vowels are common elements between this patient and other cases of FAS in non-Spanish speaking subjects. Conclusions: FAS is essentially a speech alteration; however, it can be accompanied by other physical and psychological signs. This case report allows recognizing the essential components for the definition, diagnosis and intervention of this syndrome.

Background: Foreign accent syndrome (FAS) is a rare acquired speech disorder wherein an individual’s spoken accent is perceived as “foreign.” Most reported cases involve left frontal brain lesions, but it is known that various other lesions can also cause FAS. To determine whether heterogeneous FAS-causing lesions are localized to a common functional speech network rather than to a single anatomical site, we employed a recently validated image analysis technique known as “lesion network mapping.” Methods: We identified 25 published cases of acquired neurogenic FAS without aphasia, and mapped each lesion volume onto a reference brain. We next identified the network of brain regions functionally connected to each FAS lesion using a connectome dataset from normative participants. Network maps were then overlapped to identify common network sites across the lesions. Results: Classical lesion overlap analysis showed heterogeneity in lesion anatomical location, consistent with prior reports. However, at least 80% of lesions showed network overlap in the bilateral lower and middle portions of the precentral gyrus and in the medial frontal cortex. The left lower portion of the precentral gyrus is suggested to be the location of lesions causing apraxia of speech (AOS), and the middle portion is considered to be a larynx-specific motor area associated with the production of vowels and stop/nasal consonants and with the determination of pitch accent. Conclusions: The lesions that cause FAS are anatomically heterogeneous, but they share a common functional network located in the bilateral posterior region of the frontal lobe. This network specifically includes not only the lower portion of the central gyrus, but also its middle region, which is referred to as the larynx motor cortex and is known to be associated with phonation. Our findings suggest that disrupted networks in FAS might be anatomically different from those in AOS.

Background: Foreign accent syndrome (FAS) is arare syndrome associated with altered speech rhythm and prosody, which listeners perceive as foreign; cerebrovascular accidents, tumors and multiple sclerosis are reported as possible causes of FAS. The pathophysiology of FAS is not yet understood.Case Presentation: A 68-year-old Italian man was admitted to the EmergencyDepartment for non-fluent aphasia and dysarthria. Computed tomography (CT) scan did not show abnormalities; the patient was treated with systemic thrombolysis. A repeated brain CT and magnetic resonance imaging (MRI) confirmed an infarct in the left primary motor cortex and mild extension to cortico-subcortical frontal regions. In the following days he gradually improved, speaking Italian fluently with a typical German accent. In conclusion, FAS is a rare motor speech disorder, often related to cerebrovascular accidents involving critical regions in the dominant hemisphere. In addition, the present case adds further evidence to the role of the left primary motor cortex in modulation of prosody. In rare cases FAS can be the only sign of stroke or can appear after recovery from post-stroke aphasia. [ABSTRACT FROM AUTHOR]

Highlights • The typical FAS patient is a monolingual, right-handed female in her early 50 s. • Organic FAS is most often caused by stroke. • Lesions are typically in the premotor or motor cortex and in projections to these. • FAS is typically accompanied by aphasia, dysarthria and/or apraxia of speech. • Neurocognitive problems in FAS patients are variable. Abstract Foreign Accent Syndrome (FAS) is an intriguing motor speech disorder which has captured the interest of the scientific community and media for decades. At the moment, there is no comprehensive model which can account for the pathophysiology of this disorder. This paper presents a review of 112 FAS cases published between 1907 and October 2016: these were analyzed with respect to demographic characteristics, lesion location, associated neurocognitive symptoms, and comorbid speech and language disorders. The analysis revealed that organic-neurogenic FAS is more frequent in women than in men. In organic-neurogenic FAS over half of the patients acquired the foreign accent after a stroke. Their lesions are typically located in the left supratentorial regions of the brain, and generally involve the primary motor cortex and premotor cortex (BA 4 and 6), and/or the basal ganglia. Although neurocognitive data are not consistently reported, vascular FAS patients regularly suffer frontal executive dysfunctions. On the basis of a careful comparison of the cognitive and theoretical accounts of FAS, AoS and ataxic dysarthria, it is concluded that FAS should be regarded a dual component motor speech disorder in which both planning and motor execution of speech may be affected. [ABSTRACT FROM AUTHOR]

Foreign accent syndrome (FAS) is a rare, poorly understood speech disorder. It is characterized by the patient speaking their native language in a different accent foreign to both the speaker and the listener. A majority of previously reported cases have been described in patients with diagnosed organic brain damage and a handful of other psychiatric disorders. FAS was not the result of language experience in our index patient, and there is no history of the patient ever visiting the United States of America. This case is presented because it is the first-ever seen case in the environment. [ABSTRACT FROM AUTHOR]

Foreign accent syndrome (FAS) is a relatively rare speech motor disorder in which the pronunciation of an affected speaker is perceived as distinctly foreign by listeners of the same language community. Because of various close semiological resemblances with apraxia of speech, FAS has been hypothesized to be an apraxia subtype. In 2009 two cases of developmental FAS (dFAS) were described in whom the disorder was detected in an early stage of their speech-language development in the absence of brain damage or mental illness. In the present study, two listening panels consisting of 30 native speakers of two regiolects, Dutch and Flemish, evaluate the spontaneous speech of two native Flemish-speaking boys with suspected dFAS, three native Flemish-speaking children diagnosed with developmental apraxia of speech (dAoS), two bilingual children (L1 = Flemish, L2 = French or English), and six native Flemish-speaking children with typical speech-language development. Whereas the Dutch panellists were not able to distinguish the different groups, the Flemish listeners accurately identified the children with dFAS and the bilingual children. None of the listeners were able to discern between dFAS and dAoS. The latter finding supports the assumption that the two speech disorders not only share similar semiological and perceptual characteristics but also a common pathophysiological substrate. Although it is not always identified by listeners of the same language community but is by speakers of the same regiolect, in addition to FAS resulting from brain damage or a psychological disorder, dFAS appears a distinct form of apraxia of speech resulting from developmental deficits. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this case report is to demonstrate a possible alternative etiology related to dopamine may exist for foreign accent syndrome (FAS). Methods: A 79-year-old, 205 pound, Caucasian woman originally presented to the department of Neurology for treatment and subsequently to the pharmacist pharmacotherapy service for evaluation of bilateral upper extremity tremor of high amplitude but was found to also exhibit FAS. Discussion: This case report contributes to the limited literature regarding foreign accent syndrome and adds to the few case reports of psychogenic origin, as opposed to the majority, which are of neurogenic origin. This also represents the first case that seems related to withdrawal of medication rather than psychotic exacerbation and ranks a six on the Naranjo algorithm. Conclusion: FAS is a rare disorder and little is understood about it. This case presentation also suggests that chronic use of high-dose dopamine and/or anticholinergic agents may alter pathways in the brain, which in this case, may have potentially contributed to the development of FAS. There remain many unanswered questions regarding FAS, but hopefully more clarity may be found as more cases are discovered and published. Conflict of Interest I declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties. Type: Case Study

Background: Foreign accent syndrome (FAS) is a rare speech disorder leading to a perceived presence of a new accent in a speaker’s speech. Until now, around 100 cases of FAS have been reported. It is striking that in most cases the perception of the accent is in one consistent direction, namely from languages like English or Dutch to accents of Romance, Germanic, Eastern European or tonal languages. Aims: In this article, we will try to come up with an overarching explanation for the accent changes seen in FAS, relating these changes to force of articulation. Main Contribution: We assume that the foreign accent in FAS is interpreted on the basis of the stereotypical segmental and prosodic characteristics that relate to the phonetics and phonology of specific languages. We hypothesise that the direction in perception of a FAS accent will go from a language characterised by relatively more lenition processes, into languages with relatively more fortition characteristics in their phonetic realisations and phonological system and not the other way around. Accents are expected to change from stress-timed to syllable-timed languages, from weight-sensitive stress systems to weight-insensitive systems, from non-aspirated to aspirated systems, and within these language groups from languages characterised by, for example, relatively more reduction and assimilation processes to languages with relatively less lenition. We have tested our hypothesis with the already described FAS cases. We restricted ourselves to the cases of neurogenic FAS described in English and to which enough details were provided in order to be able to judge the change of accent. Conclusions: From the 58 cases that fitted with these criteria, almost 90% showed a change of accent in the expected direction or did not contradict our hypothesis. Only six accent changes did not directly support it. The reported phonetic descriptions of the cases, if available, nevertheless suggest that they do not seem to completely violate our hypothesis. [ABSTRACT FROM AUTHOR]

Foreign accent syndrome is a rare motor speech disorder that causes patients to speak their language with a non-native accent. In the neurogenic condition, the disorder develops after lesions in the language dominant hemisphere, often affecting Broca's area, the insula, the supplementary motor area and the primary motor cortex. Here, we present two new cases of FAS after posterior fossa lesions. The first case is a 44-year-old, right-handed, Dutch-speaking man who suffered motor speech disturbances and a left hemiplegia after a pontine infarction. Quantified SPECT showed a bilateral hypoperfusion in the inferior lateral prefrontal and medial inferior frontal regions as well as a significant left cerebellar hypoperfusion. Further clinical investigations led to an additional diagnosis of brainstem cognitive affective syndrome which closely relates to Schmahmann's syndrome. The second patient was a 72-year-old right-handed polyglot English man who suffered a stroke in the vascular territory of the left posterior inferior cerebellar artery (PICA) and developed a foreign accent in his mother tongue (English) and in a later learnt language (Dutch). In this paper, we discuss how the occurrence of this peculiar motor speech disorder can be related to a lesion affecting the posterior fossa structures. [ABSTRACT FROM AUTHOR]

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The main objective of this research is to study the scientific literature concerning the treatment in the field of the speech therapy or therapeutic treatment of language in 'Foreign Accent Syndrome' (FAS). It was performed with a systematic review of all the documents (with more than a page of length) available from 2001 to 2015, both inclusive. These documents were retrieved from all the databases belonging to, or incorporated into, the Web of Science (including Medline), ERIC and TESEO. Eight references were selected, five of them were included because those fulfilling the inclusion criteria proposed. After a detailed analysis of those references, were presented the different treatments of language applied or proposed for the patients diagnosed with FAS. Nowadays we found a great ignorance about what concerned the clinical practice of rehabilitation. This will enable a greater interdisciplinary perspective, as well as a new knowledge point of view, for language professionals in some processes or therapeutic techniques that could help to support the recovery. [ABSTRACT FROM AUTHOR]

This paper presents the case of a 33-year-old, right-handed, French-speaking Belgian lady who was involved in a car accident as a pedestrian. Six months after the incident she developed a German/Flemish-like accent. The patient’s medical history, the onset of the FAS and the possible psychological causes of the accent change are analyzed. Relevant neuropsychological, neurolinguistic and psychodiagnostic test results are presented and discussed. The psychodiagnostic interview and testing will receive special attention, because these have been underreported in previous FAS case reports. Furthermore, an accent rating experiment was carried out in order to assess the foreign quality of the patient’s speech. Pre- and post-morbid spontaneous speech samples were analyzed phonetically to identify the pronunciation characteristics associated with this type of FAS. Several findings were considered essential in the diagnosis of psychogenic FAS: the psychological assessments as well as the clinical interview confirmed the presence of psychological problems, while neurological damage was excluded by means of repeated neuroimaging and neurological examinations. The type and nature of the speech symptoms and the accent fluctuations associated with the patient's psychological state cannot be explained by a neurological disorder. Moreover, the indifference of the patient towards her condition may also suggest a psychogenic etiology, as the opposite is usually observed in neurogenic FAS patients.

In the majority of cases published between 1907 and 2014, FAS is due to a neurogenic etiology. Only a few reports about FAS with an assumed psychogenic origin have been published. The present article discusses the findings of a careful database search on psychogenic FAS. This review may be particularly relevant as it is the first to analyze the salient features of psychogenic FAS cases to date. This article hopes to pave the way for the view that psychogenic FAS is a cognate of neurogenic FAS. It is felt that this variant of FAS may have been underreported, as most of the psychogenic cases have been published after the turn of the century. This review may improve the diagnosis of the syndrome in clinical practice and highlights the importance of recognizing psychogenic FAS as an independent taxonomic entity.

A 40-year-old, non-aphasic, right-handed, and polyglot (L1: French, L2: Dutch, L3: English) woman with a 12 year history of addiction to opiates and psychoactive substances, and clear psychiatric problems, presented with a foreign accent of sudden onset in L1. Speech evolved towards a mostly fluent output, despite a stutter-like behavior and a marked grammatical output disorder. The psychogenic etiology of the accent foreignness was construed based upon the patient’s complex medical history, and psychodiagnostic, neuropsychological, and neurolinguistic assessments. The presence of a foreign accent was affirmed by a perceptual accent rating and attribution experiment. It is argued that this patient provides additional evidence demonstrating the outdatedness of Whitaker’s (1982) definition of Foreign Accent Syndrome, as only one of the four operational criteria was unequivocally applicable to our patient: her accent foreignness was not only recognized by her relatives and the medical staff, but also by a group of native French-speaking laymen. However, our patient defied the three remaining criteria, as central nervous system damage could not conclusively be demonstrated, psychodiagnostic assessment raised the hypothesis of a conversion disorder, and the patient was a polyglot whose newly gained accent was associated with a range of foreign languages, which exceeded the ones she spoke.

Foreign accent syndrome (FAS) is a speech disorder that is defined by the emergence of a peculiar manner of articulation and intonation which is perceived as foreign. In most cases of acquired FAS (AFAS) the new accent is secondary to small focal lesions involving components of the bilaterally distributed neural network for speech production. In the past few years FAS has also been described in different psychiatric conditions (conversion disorder, bipolar disorder, and schizophrenia) as well as in developmental disorders (specific language impairment, apraxia of speech). In the present study, two adult males, one with atypical phonetic production and the other one with cluttering, reported having developmental FAS (DFAS) since their adolescence. Perceptual analysis by naïve judges could not confirm the presence of foreign accent, possibly due to the mildness of the speech disorder. However, detailed linguistic analysis provided evidence of prosodic and segmental errors previously reported in AFAS cases. Cognitive testing showed reduced communication in activities of daily living and mild deficits related to psychiatric disorders. Psychiatric evaluation revealed long-lasting internalizing disorders (neuroticism, anxiety, obsessive-compulsive disorder, social phobia, depression, alexithymia, hopelessness, and apathy) in both subjects. Diffusion tensor imaging (DTI) data from each subject with DFAS were compared with data from a group of 21 age- and gender-matched healthy control subjects. Diffusion parameters (MD, AD, and RD) in predefined regions of interest showed changes of white matter microstructure in regions previously related with AFAS and psychiatric disorders. In conclusion, the present findings militate against the possibility that these two subjects have FAS of psychogenic origin. Rather, our findings provide evidence that mild DFAS occurring in the context of subtle, yet persistent, developmental speech disorders may be associated with structural brain anomalies. We suggest that the simultaneous involvement of speech and emotion regulation networks might result from disrupted neural organization during development, or compensatory or maladaptive plasticity. Future studies are required to examine whether the interplay between biological traitlike diathesis (shyness, neuroticism) and the stressful experience of living with mild DFAS lead to the development of internalizing psychiatric disorders. [ABSTRACT FROM AUTHOR]

Neurogenic foreign accent syndrome (FAS) is diagnosed when listeners perceive speech associated with motor speech impairments as foreign rather than disordered. Speakers with foreign accent syndrome typically have aphasia. It remains unclear how far language changes might contribute to the perception of foreign accent syndrome independent of accent. Judges with and without training in language analysis rated orthographic transcriptions of speech from people with foreign accent syndrome, speech-language disorder and no foreign accent syndrome, foreign accent without neurological impairment and healthy controls on scales of foreignness, normalness and disorderedness.Control speakers were judged as significantly more normal, less disordered and less foreign than other groups. Foreign accent syndrome speakers’ transcriptions consistently profiled most closely to those of foreign speakers and significantly different to speakers with speech-language disorder. On normalness and foreignness ratings there were no significant differences between foreign and foreign accent syndrome speakers. For disorderedness, foreign accent syndrome participants fell midway between foreign speakers and those with speech-language impairment only. Slower rate, more hesitations, pauses within and between utterances influenced judgments, delineating control scripts from others. Word-level syntactic and morphological deviations and reduced syntactic and semantic repertoire linked strongly with foreignness perceptions. Greater disordered ratings related to word fragments, poorly intelligible grammatical structures and inappropriate word selection. Language changes influence foreignness perception. Clinical and theoretical issues are addressed. [ABSTRACT FROM AUTHOR]

In the majority of cases published between 1907 and 2014, FAS is due to a neurogenic etiology. Only a few reports about FAS with an assumed psychogenic origin have been published. The present article discusses the findings of a careful database search on psychogenic FAS. This review may be particularly relevant as it is the first to analyze the salient features of psychogenic FAS cases to date. This article hopes to pave the way for the view that psychogenic FAS is a cognate of neurogenic FAS. It is felt that this variant of FAS may have been underreported, as most of the psychogenic cases have been published after the turn of the century. This review may improve the diagnosis of the syndrome in clinical practice and highlights the importance of recognizing psychogenic FAS as an independent taxonomic entity. [ABSTRACT FROM AUTHOR]

This paper presents the case of a 17-year-old right-handed Belgian boy with developmental FAS and comorbid developmental apraxia of speech (DAS). Extensive neuropsychological and neurolinguistic investigations demonstrated a normal IQ but impaired planning (visuo-constructional dyspraxia). A Tc-99m-ECD SPECT revealed a significant hypoperfusion in the prefrontal and medial frontal regions, as well as in the lateral temporal regions. Hypoperfusion in the right cerebellum almost reached significance. It is hypothesized that these clinical findings support the view that FAS and DAS are related phenomena following impairment of the cerebro-cerebellar network. [ABSTRACT FROM AUTHOR]

A 40-year-old, non-aphasic, right-handed, and polyglot (L1: French, L2: Dutch, and L3: English) woman with a 12-year history of addiction to opiates and psychoactive substances, and clear psychiatric problems, presented with a foreign accent of sudden onset in L1. Speech evolved toward a mostly fluent output, despite a stutter-like behavior and a marked grammatical output disorder. The psychogenic etiology of the accent foreignness was construed based on the patient's complex medical history and psychodiagnostic, neuropsychological, and neurolinguistic assessments. The presence of a foreign accent was affirmed by a perceptual accent rating and attribution experiment. It is argued that this patient provides additional evidence demonstrating the outdatedness of Whitaker's (1982) definition of foreign accent syndrome, as only one of the four operational criteria was unequivocally applicable to our patient: her accent foreignness was not only recognized by her relatives and the medical staff but also by a group of native French-speaking laymen. However, our patient defied the three remaining criteria, as central nervous system damage could not conclusively be demonstrated, psychodiagnostic assessment raised the hypothesis of a conversion disorder, and the patient was a polyglot whose newly gained accent was associated with a range of foreign languages, which exceeded the ones she spoke. [ABSTRACT FROM AUTHOR]

Foreign Accent Syndrome (FAS) is a rare phenomenon where speech is characterized by a new accent to the patient’s native language. More than 100 cases with the syndrome have been published, the majority of which were associated with observed insults of the speech center. Some other cases have been described without identifiable organic brain injury, especially in patients with psychiatric illness. This paper presents a patient with schizophrenia and FAS, without any evidence of organic brain injury. FAS recurred during psychotic exacerbation and did not reverse before transfer to a long-term psychiatric facility. The case is discussed in the context of a brief review of the syndrome. [ABSTRACT FROM AUTHOR]