Foreign Accent Syndrome and Different Types of Aphasia

A boy from Britain who had a case of viral meningitis had to undergo surgery to drain the fluid from his brain. When he awoke and recovered, he had a new accent:

William McCartney-Moore of York was struck down with viral meningitis last March and needed brain surgery after doctors found he had a rare strain called empyaema. "He lost everything," said his mother, Ruth. "He couldn't read or write, he couldn't recognise things, he had no recollection of places he'd been to and things he'd done and he'd lost all his social skills. He went from being such a bright, lovely, wonderful eight-year-old who was totally confident and socially aware, to being a two-year-old who followed me everywhere like a toddler."

William surprised doctors by making a good recovery after the surgery but his mother was more baffled to hear that William's Yorkshire twang had been replaced with a far more posh-sounding accent: "He went in with a York accent and came out all posh. He no longer had short 'a' and 'u' vowel sounds, they were all long." He has returned to school and is near to a full recovery from his illness.

The transformation has the hallmarks of a well-documented but rare condition called foreign accent syndrome (FAS), where a brain injury can cause a person to end up speaking very differently. In many cases the muscle groups in the lips, tongue and vocal chords lose coordination and speech changes in terms of timing, intonation or even where the person places their tongue. Although the speech usually remains intelligible, it is perceived as different by others.

(Incidentally empyaema is not a strain of virus. It is what happens when a pus-like fluid builds around the brain or another structure. The surgery was to remove the pressure on the brain.)

So what is the deal with this kid? Why would someone wake up with trouble speaking, and why would their accent change?

First, let's define some terms. I want to use this case as an opportunity to summarize what is known generally about neurological lesions and speech.

Aphasia is the inability to speak or understand language following a neurological injury. There are two big types of aphasia (and many little ones but let's keep this simple). Wernicke's aphasia is the inability to comprehend speech. It results from lesions to the left hemisphere of the brain around the back end of the lateral fissure. (Depicted in the diagram below.)


People with Wernicke's aphasia don't understand the speech of others or that the speech that they produce themselves. Because they cannot even understand self-produced speech, their sentences tend to not make sense. They use a lot of neologisms that neurologists call a "word salad."

Below is a video of a patient with Wernicke's aphasia from the Wisconsin Physio Dept. website:

Note that the patient has no trouble producing appropriate sentence rhythm. He can make words; he just cannot find the right word. (This is INCREDIBLY frustrating for the patient. Wernicke's is definitely in the top ten of diseases I don't want.)

We can contrast Wernicke's aphasia with Broca's aphasia. In Broca's aphasia the patient understand their own words and the words of others just fine. They have trouble producing words. This produces a sort of choppy speech with disrupted sentence structure. The words that get out are the right words, but the patient has trouble getting those words out.

Below is a video of a patient with Broca's aphasia from the Wisconsin Physio Dept. website:

There are some important things to remember about aphasias.

  • While most aphasias are caused by strokes, not all of them are. As in the case of the little boy above, they can be caused by infection. They can also be caused by trauma or by mass lesions like tumors.
  • The presentation and severity of aphasias is highly variable. It depends on the particular patient.
  • The prognosis for aphasia is also highly variable. It depends on how you got the aphasia and how old you are.

Now let's talk about the foreign accent syndrome (FAS).

The boy's clinical case shows a characteristic pattern for people with neurological damage. He had substantial impairment, as shown by his mother's reports, followed by a certain degree of recovery. (In his case a very large recovery.) He lost his speech -- he had aphasia -- but then when it came back he had a new accent.

There are two questions that I would ask about FAS:

  • 1) Is the new accent in FAS a true accent?
  • 2) What is the mechanism of improvement?

With respect to the first question, the evidence suggest that the new accents in FAS are not true accents. Kurowski et al. summarize the evidence for how FAS results in a pseudoaccent:

It has been suggested that FAS does not reflect any particular foreign accent but rather is characterized by a "generic foreign accent" (Blumstein et al., 1987, p. 243; cf. also Gurd, Bessel, Bladon, & Bamford, 1988; Ingram et al., 1992). Detailed acoustic analyses of the speech production of a single FAS patient by Blumstein et al. (1987) revealed that the anomalous features reflected patterns of speech found in the regular sound structures of human language, although not necessarily of the patient's native language. None of these speech features were pathological in the sense that they violated the phonetic rules of language, as is the case for Broca's aphasics or patients with other speech production problems. For example, while the large Fo excursions at the end of phrases reported by Blumstein et al. in their patient's data do not occur in English, they occur in other languages such as French, and, while their patient made voicing errors, the production of VOT reflected normal English patterns. Likewise, a failure to observe the speech production rule in English which reduces medial [t, d] to flaps after a stressed vowel that had been reported by both Blumstein et al. (1987) and Ingram et al. (1992) must be viewed in light of the fact that other languages do retain full stops in such vowel contexts. Thus, although listeners perceive the speech patterns of FAS patients as nonnative, these speech patterns nonetheless reflect phonetic properties which occur in the inventory of sounds found in the languages of the world. As a consequence, listeners categorize these deviations as stereotypically "foreign" (cf. Blumstein et al., 1987; Gurd et al., 1988; and Ingram et al., 1992 for discussion). (Emphasis mine.)

(Kurowski et al. go on to show the diversity of presentation in FAS, but the idea the it results in a pseudoaccent is not disputed by their work.)

What this means is that while the new accent may sound like the person is from another place, this is only because the person has lost the use of certain pronunciations in their language. They use new ones drawn from other languages that makes their speech sound foreign. This technical term for difficulties in the motor coordination of speech is dysarthria. Also, this suggests that FAS is not a Broca's aphasia -- a difficulty in speech production -- in the strictest sense. According to the formal definition, Broca's aphasia is when speech production violates pronunciation rules in any language. FAS does not violate pronunciation rules. It just mixes them from multiple languages.

It is an interesting side question to ask whether the person understands the idioms in the new accent. The prediction is obviously that they do not.

With respect to question two, there are many parts of the improvement. When the swelling goes down, there will be an immediate improvement. Also, there is a degree of rewiring that takes place as the neurons heal themselves. (This is more pronounced the younger the patient is, and the fact that he is young says a lot about why he recovered.) Finally, there is functional compensation that allows the individual to work around whatever deficits remain.

I think that these different parts of compensation say a lot about the mechanism of FAS. The person with FAS probably loses in degrees the ability to pronounce specific syllables in specific ways. They compensate for these losses by employing alternative pronunciations that they are aware of. This may be in part an example of rewiring, and it may be in part functional compensation.

Fortunately for the boy above, the prognosis for his accent is good. A doctor interviewed for the BBC coverage indicated that his accent would likely return over time:

Dr Coleman told BBC News Online: "There is a good likelihood in time you are going to improve and become more like you used to be."

More like this

Interesting post. I'm left wondering -- are the new accents of polyglot speakers (esp. bilinguals, who are more likely to have a fully native accent in both languages) affected by the phonologies of other languages that they know. That is, might a bilingual English-Spanish speaker begin turning voiced stops to fricatives between vowels in English or aspirate voiceless stops in Spanish? Or is it entirely random what new phonological patterns emerge?

My guess (which is only a guess, I haven't gone through the literature) would be that pronunciation would revert to the least marked variation, cross-linguistically, of a particular rule. That would make sense if the idea of a universal grammar is correct, anyway.

I just had a couple of comments on your post.
First, I would definitely rather have Wernicke-type of Aphasia than Broca, as a matter of fact, Broca patients show more frustration because they are aware of their errors; Wernicke patients (as you can gather from the video) are not really aware of their difficulties.
In regards to your first question, there are many researchers that think that FAS does not result in a real accent, that it is a perceptuallly-based explanation of the symptoms and it's diagnosis is entirely subjective. I would even say that only Linguists, Speech Pathologist, or professionals with the preparation to perform a phonological analysis of a speech sample would be able to find the consistencies found in the "accent" of a patient with FAS. To any other listener they plainly sound "foreign".
Also, I'm not too sure the difference you make with Broca is clear, the main distinction would be that while Broca is a Language disorder, this syndrome, just like Dysarthria is more of a Speech mechanism issue, uncoordinated mov. etc. This is why I would venture to say that understanding idioms would NOT be impaired, because it's is not a Language problem, but merely Speech (the motor act).
Finally, I agree with the last comments you make about it being a way of compensating for difficulties producing specific phonemes, a very innovative way, I would add.
In regards to the comment posted, I think that most cases reported talk about patients developing characteristics (or accents) of languages they have never had contact with, but that probably doesn't mean it's not possible. Although I wouldn't think they would apply phonotactic rules from one of their spoken languages to the other, especially if they were equally affected (or unaffected) by the brain damage.

Hello friends,

First of thanks for letting those little eyballs roll over this way to read this.

Unbeknownst to me I have been having seizures and now I lost my speech. Then after constantly and obsessively trying to find my words, I was told I sound different, very different. Let me explain.

My husband looked at me and even rather irritated, "why are you talking that way?"

"Talking what way?", I said with a bit of a defensive expression on my face.

"That foreign stuff," (still irritated)

What foreign stuff, I don't understand what you are talking about."

So, can you guess what this woman did, that's me I'm speaking of. I had to listen to myself speak. I didn't hear it until I saw a few days later a movie with British sounding accents and It was like I belonged in that movie!

"Where's my script? "I thought.

Oh, surely I am just making this up! So what did I do to figure out whether or not it was me, a show,or a product of someone suffering from multiple personlity disorder, you may be wondering, come on readers, just admit it. I tried to say ya'll, this my husband picked on me for saying so much, and other words I noticed I wasn't saying, my mouth would not even move correctly, like my mouth just couldn't go there. You think like my silly husband did. Notice I said did. He doesn't anymore. He knows its me, He knows I cant make this up, and so does my huge loving family, some of which I haven't seen in sometime. So what should I do? I should just keep on going and move on to the next step. Acceptance. Hey I've gotta say, those seizures hit in the right spot. I am still having seizures. I have many disorders. But I am a smart woman with a wonderful family that is right with me. That includes all of my brother and sisters. I told you, Lots to love and lots to live for.
What brought on the seizures, I believe is to little of a threshold factor for frustrating external stimuli.I do have Conversion Disorder and I also have Somatization disorder and hypochondria, Fibromyalgia, Bipolar depression, Anxiety disorder, Fibrocystic Disease, Sinus Disease, Paranoia, PMS, mild scoliosis and heightened senses, which causes me to enjoy life to the fullest Or opposite be quick to notice smells, details, texture, pattern and depth, bad food, I think in illustrations and injustice and negativity are not allowed in my brain. My skin will crawl, I will shut down, and I want to leave,SO don't judge me and use insight and realize that abuse I have experienced have been suppressed and it has exhibited itself in monsterlike disorders. Now that doesn't mean I am surrendering to this. I believe we were made to heal. So with positive thinking, a reliance on Jehovah, I can mentally and spiritually rise above it and keep on going, including baby steps toward goals I want to ccomplish. But only within reasonable limits.
Can you see how each would feed or cause the other and how your brain truly causes many problems. I do feel like I have been so critical of myself and others, because I have thought of myself in such a bad way. I see now how I was trying to make myself feel better.But I absolutely had no idea. I thought I was doing good. Yeah right. That floor was slippery I was on. I thought since I was about 18 I was doing this to myself. Really when someone goes through terrible life experiences it becomes a part of you. You absolutely need to accept that it happened, embrace it like you would an injured being, hold it, love it, pamper it, You may not see the damage on the outside but inside there is internal damage. You must stop stereotyping those of us who have suffered abuse, especially ones like myself and someone else in my family, who would never repeat such a hideous thing. That is a choice and a will to do what is proper. I have so much love to give and I just want everyone to know life is worth living, even if you have wounds. Lets bandage up, and let others love us properly, with dignity on both sides, and us love them and ya know what, you will be a much happier person. I have another reason why I am happy, I live by Bible principles which beats relying on human wisdom. When you stand on solid ground you can't sink. So my hearts desire is for all my global neighbors to stand on solid ground. I love you people. I can tell, you just needed a hug.

Your neighbor,

T. Sisneroz

Ps. If you would like to email me my address is I can type better, and it's easier to type.

If you are just going to email to play games with me, remember my life is special and if negativity comes through it can affect me in terrible ways. And while you write foolishness you're only training your brain to be mentally lazy. So please train that brain and think proper.
Please do not send me experiences. And do not forward my experience through the email system. Let Jehovah do that if it his will, let's be obedient to our shepherds, my fellow sheep.

Thank you in advance.

I would also like to thank Dr. Brown and Elizabeth Bivens from Plaza Medical Center, for your proper diagnosing, and Mercy Emergency Center for their kindness and the 'I'm sure just as frustrating experience with this situation, what is going on with this woman, why does she keep coming back? She must be a little looney feeling'
Well you may feel that way at times but you still were kind and you still took care of me each time and made me feel comfortable. Just as you are supposed to do. I want to especially thank Dr. Prytkov, Dr. Smedlund, Dr. Reddmund, Dr. Raju, and Dr. Reames. Also Amy at Mercy. You listen well and advised me properly. Also at Edmond Medical Emergency, they recognized it was in my head. I'm glad it was in my head.

I also want to thank my Grandma for not letting me go
my Grandpa for helping me out financially while i was making such terrible financial decisions. I should only keep paintbrushes in my hand and leave the money to the honey. My aunts uncles cousins and especially Dannah and Kristen, my lovely sisters, and their mother. I love you all.

I also want to thank my Momma for letting my pinch her legs.
I've gotta say if I have any mellowness whatsoever in me, I get it from my Momma. She's always told me to lighten up, and I have. Jehovah gave me his spirit. I'm me. I'm alive
and well. Mom, I'm light as a feather.

My sister Brittany, for forgiving me for being such a mean big sister and even though we were not close as children we've got a lot of catching up to do. Thank you for your forgiveness.

My sister Briggette. For being my buddy. For letting my be myself and opening up to me and loving me for who i am. You stay level headed since you work at a bank, could you teach me the concept of handling money properly? Hahaha...

My brother and Sofia, for giving me the cutest little nephew ever. He loves me more Briggette! Bobby you may not know this, but I love you so much it ain't funny. I'll teach your son how to speak with an accent. No Diego here.

All of the brothers and sisters who came over and ones who inquired of me well being and didn't give me silly looks. I know who you are and you do too. Thank you. A true companion is loving all the time--That's what the bible says. Lets keep it up friends. I will show love, you show love, turn around and show love to others, lets turn this kindom hall into a game of dominos.

That goes for my family too.

I also want to especially thank you, yes, you. for listening.

By the way, my dear neighbors, please give our doctors and nurses a little more credit. If some say its in your head, It may or may not be true. but be balanced, they must check for other illnesses first, listen with their ears open like a trombone and connect with the patient, lose the stereotyping. And Remember I'm not promoting anything here. The Bible moreless says we pack our own bags.
Someone who exhibits these actions, we are still people. We can be happy we can be sad, we can cry, we can eat, we can have friends, some of us may have trouble communicating, have more trouble in relationships, but really, if you would just slow down your motor, and look out the window, you'd see there we are waiting for a ride. Our thumbs are up and your just too afraid to pick us up. What I mean by that is you have your agenda, your way, your idea of what life is supposed to be and look like based on your life experience. Well I have some news and I want you to read all about it.
We've had different life experiences than you, and unless you get out of the negative car and start driving the positive car you will never be able to take your foot off the brake. It's like your brake says Happiness and your gas pedal says fear of man and or negative thinking. Get out of that car and ride the one that has the pedal of life. If you don't think like that then you are way ahead of me, because I did. I don't now. But it took Jehovah's spirit and fervent prayer, supplicating Jehovah, looking towards the heavens telling him, I know you used the same holy spirit to part the red sea, to fill the upper room with holy spirit and cause diverse languages, I know its me that had been lacking faith, and so I begged Jehovah to help me where I needed faith, I said I will not put any limitations on you Jehovah, but boy I sure feel differenty than what is coming to my mind, so I need to connect here and you are the only one who will help me to be there for my family, have no fear, be loving as I just would yearn to do but would hide from it because I didn't trust others with my heart. THen about 4 days later it hit me, not like a light bulb, a lightning bolt. Wow, I saw powerflashes. You must know that my loving you and overcoming this is not on my own, its the scripture in action where Jehovah can overturn entrenched things. You just have to let him. He'll feel it in with dirt. I think he sent out lots of dump trucks and lined them up and all at once said, on the count of ten I want you to fill these up. 1,2,3,4,5,6,7,8,9,10!

It felt like I found the truth all over again. I took those clothes off(the old personality)and put on the new one,I threw them in the trash, Forget donating them,
They are worn out and smell putrid. I shop quality now.
Hey friends I know you like to shop. Let's shop toether.

How about lets live love and shop freely. Want to?

By Tina Sisneroz (not verified) on 18 Jun 2008 #permalink

The doctors have narrowed it down to an extreme case of Conversion Disorder. My body rejects stress. My muscles in my throat were affected and I still speak different. I feel relieved my doctors are true professionals. And they took an active interest in me. I am going to therapy beginning soon. This will be interesting. I love life. I'm ready to live it and not let stress dictate my daily agenda. How about you?

By Tina Sisneroz (not verified) on 09 Jul 2008 #permalink

I realize I speak freely of my faith, however if you do not believe what I do, it is still important to understand the illness, what I believe is part of me, and this post was from my heart. I can not discuss that part, but it still is inside me. I do respect others and their freedom to worship as they please. I just wanted to clarify this.

It was suggested to me I should write a book by my Medical Doctor being I have an extreme form of Conversion Disorder with pseudoseizures and paralysis being my chief complaint.

By Tina Sisneroz (not verified) on 10 Jul 2008 #permalink

I just recently had a friend suffering, she says, from multiple personality disorder. i explained to her that although we have all of these symptoms, we are not suffering. We are blessed with the ability to use, in my case the right side of our brain. I got her chin and wiggled it like a momma would her adorable child, not that I am her mother, but But I thought I was suffering too. Maybe in a sense that is true. But if we look at it like we just need to use our brain more. Read, write, if you can do math then do it. When I was in school i was in honors, then after much abuse i began to lose my grades, etc....I was on the presidents roll. i have awards to prove that it all stopped once I began to be abused. Isn't that interesting. And if every abusive relationship i have been in since then, I have shut down and began to fail proffesionally. It's no that others are to blame for how we handle stress. But it wouldn't happen and doesn't happen with positive energy around you. Did you know that 25-75% of all of the doctors visits are related to psychosomatic ailments? More than myself are suffering from this converting stress into physical ailments stuff. I have noticed as I watch people that when negative things start taking place around them they begin to twitch, they start rubbing their arms. They begin to exhibit pain. Start stating things, such as "I need a Tylenol" What I have seen also is a simultaneous justification that there is some reason that this is happening. Why? Isn't it such a better route to just say, "It's all in my head?" Now some things must take place due to true organic disease, but for the rest of us who are as healthy as a , well i was trying to think of a simile, anyways, if you have positive feedback and tell yourself what to think, rather than let others dictate what you will do, or predict your future through prognosis, live your life. Have a picnic in your frontyard if you want to, name a butterfly, talk cute to animals, tell people how you love them, cuddle your kids, love them, let them be free and fly even as children, and don't just spank them out of anger. help love em, pamper them, or they will need to leave you someday as I have had to do various ones in my own life. teach them be who they can be by showing them recources they have around them so that they can tap into their own reservoir of knowledge in their brain and link knowledge wisdom and understanding together. Showing them, not preaching at them or commanding it, they are like adults in some ways, they need to aspire to be who they are not by comparison, etc...Those people are the ones who are successful. sound principles to live by. i just don't know what else you could do that would be better. Does anyone remember why Solomon was so rich, why job was, why Abraham was blessed/ it was because their solid foundation was based on wisdom. Superior than ours. We were made to use our brains, this website is awesome. Just use your brain, or you will lose it, just like they say.

I feel fine, by the way, the more i use my brain, the less stress i am around, the more that i live and sing, and laugh and love, the more I am exhibiting less psychosomatic ailments. Are you thinking what I am thinking? its all in my head!!!!!!!!! I do not have a death wish. I have endless life in view! -OO-

Tina Orr
Tina Sisneroz, same person

Tina, please get help.

Is there a diagnosis for guys who fake foreign accents in order to impress girls? Or is that just another sad example of the increasing weirdness and lack of honesty in this country? I guess I just answered my own question.

BTW...if a person who "switches" accents and identities more frequently than their underwear, and calls themselves James Bond, I would seriously reconsider the association.

By Deborah Hill (not verified) on 27 Oct 2008 #permalink


There is a diagnosis for that, it's called "A guy who wants to impress girls"...there is a similar diagnosis for girls who fake accents.

Tina can't get help for that...she has seizures...given that she has language difficulties because of them, they are most likely in her Temporal Lobes. Temporal Lobe Epilepsy is associated with a series of traits called Geschwind's Syndrome. They include (among others) high religiousity, interpersonal "stickiness", and hypergraphia (tendancy to write.....A LOT). Perhaps you noticed those traits in her posts?...Well they can't be "helped", by her, or by professionals. They are just the way her brain works now.

By Karen Mercer (not verified) on 14 Nov 2008 #permalink

Tina, you spoke beautifully and with great wisdom. Not everyone hears your message, and that's ok. Karen, you are right, she can't be "helped" by professionals. But she cried and God helped her. She has the courage to tell, so other people can get the help they so desperately need. Thanks, Tina, for sharing your love with others.

By Stephanie (not verified) on 15 Nov 2008 #permalink