“Accent issue”: foreign accent syndrome following ischemic stroke



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.

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VD, FD, AMP D, and MVD provided clinical care to the patient. VD and AMP D drafted the first version of the manuscript, and all authors contributed to and have approved the final version of the manuscript.

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Correspondence to Vincenzo Di Stefano.

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Di Stefano, V., De Novellis, A.M.P., Dono, F. et al. “Accent issue”: foreign accent syndrome following ischemic stroke. Neurol Sci 40, 2391–2397 (2019). https://doi.org/10.1007/s10072-019-03962-9

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  • Foreign accent syndrome
  • Stroke
  • Prosody
  • Speech disorders
  • Aphasia