Clinical foreign accent syndrome evolving into a multiplicity of accents Chris Tailby a, b, c, d, * , Jacqueline Fankhauser e , Elisha K. Josev c , Michael M. Saling c, d , Graeme D. Jackson a, b, d, f a The Florey Institute of Neuroscience & Mental Health, Heidelberg, Victoria, Australia b Brain Research Institute, Heidelberg, Victoria, Australia c Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia d Austin Health, Heidelberg, Victoria, Australia e Gippsland Medical School, Monash University, Churchill, Victoria, Australia f Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia article info Article history: Received 5 June 2012 Received in revised form 28 November 2012 Accepted 28 November 2012 Keywords: Foreign accent syndrome Psychogenic Functional magnetic resonance imaging Functional connectivity Fibre-tracking abstract Foreign accent syndrome (FAS) is a speech disorder of abrupt onset in which the affected person’s spoken output is altered such that it is perceived to have the quality of a foreign accent. FAS has most frequently been reported following stroke or trauma, but the diagnostic label has also been used to capture the clinical presentation of cases of suspected psychiatric origin. We describe here the case of a 37-year-old woman, DR, admitted to emergency for slurred speech, left-sided weakness, headache, and photosen- sitivity. On clinical grounds, her presentation was of sufficient concern to administer thrombolytic therapy. On day 9 of her admission DR began to speak with a French accent. Over the following months DR’s speech alternated between at least five different accents, accompanied by associated behavioural changes. Neuropsychological evaluation and structural and functional magnetic resonance imaging studies conducted four months after her initial presentation revealed no evidence of disrupted language function or a likely causative lesion. This is, to our knowledge, the first description of FAS encompassing multiple distinct accents within a single individual. While the aetiology of DR’s initial * Corresponding author. The Florey Institute of Neuroscience & Mental Health, Melbourne Brain Centre (Austin Campus), 245 Burgundy Street, Heidelberg, Victoria, 3084, Australia. Tel.: þ61 3 9035 7020; fax: þ61 3 9025 7301. E-mail address: ctailby@brain.org.au (C. Tailby). Contents lists available at SciVerse ScienceDirect Journal of Neurolinguistics journal homepage: www.elsevier.com/locate/ jneuroling 0911-6044/$ – see front matter Ó 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jneuroling.2012.11.002 Journal of Neurolinguistics 26 (2013) 348–362