1. Reversion to a Previously Learned Foreign Accent After Stroke Presented by: Vineet Sidhu

2. Introduction Foreign accent syndrome (FAS): also known as "pseudoaccent “ or unlearned foreign language. Common features : –presence of aphasia which develops into an accent –lateralized lesion. –The language is grammatically correct, with a slight pauses between words. FAS manifested during the recovery phase after stroke. –often transient, but can be persistent.

3. Case report –48-year-old man sustained a left parietal hemorrhagic stroke resulting in right hemiparesis and the inability to speak. –As spontaneous speech emerged, he was noted to have a Broca's aphasia and a Dutch accent. –Analysis of his speech demonstrated final consonant deletion, substitution of "d" for "th“ sounds, vowel distortions, additional "uh" syllables added at the end of words, and errors in voicing. – This speech pattern has persisted for more than 5 years after the stroke. –History check found that the patient was born in Holland and lived there until the age of 5 years, when he moved to the United States with his family. –Before his stroke, he had no foreign accent.

4. Case report Computed tomography and magnetic resonance imaging of the brain showed a 3cm × 5cm hyperdense area, suggestive of hemorrhage in the left parietal area, with extension into the ventricles (fig 1).

5. Discussion Locations of the lesions seen with foreign accent syndrome were varied [and include precentral gyrus, premotor mid frontal gyrus, left subcortical prerolandic and postrolandic gyri, and the left parietal area.] No consistency in lesions that induce the syndrome. A correlation between location and recovery, patients with lesions in the premotor cortex made good recovery –While patients with precentral, primary motor, and adjacent sensory cortex had persistent symptoms.

6. It has been proposed that foreign accent syndrome results from alterations of normal language characteristics, which are interpreted as a foreign accent that is generic in nature. FAS helped us understand: –expression of hierarchical neural organization, or –the presence of multiple anatomic locations for different languages being selectively damaged, allowing expression of only the unaffected area.

7. Strengths and weakness Strengths –Had other research to back up the conclusions –Longitudinal study over 5 years long. Limitations –Case study (individual reports- not able to generalize) –Can’t determine which specific area will cause which language deficit. –speech abnormalities result in the perception of a foreign accent, rather than an interpretation of impaired speech, are unclear.

8. My opinion and future direction Clear cut and details of what criteria was used to do the study Great back ground on Foreign accent syndrome Didn’t mention if recovery process was automatic or iatric induced Paper title was misleading No introduction and no reason expressed behind why the study was done. Multilingual person can have different anatomical locations for different languages. This is interesting because brain is most plastic during infancy and that is also the best time to learn a new language but it would interesting to note how brain changes anatomically to accommodate languages learned during adulthood.

9. Reference. Roth E.J., Fink, K., Cherney L.R., Hall K.D. (1997) Reversion to a previously learned foreign accent after stroke. Arch Phys Med Rehabil,78,550-552.

10. Questions?