Disclosures: Nathan T. McKenty, MD, MPH: No financial relationships or conflicts of interest

Case Diagnosis: Foreign accent syndrome, pediatric traumatic brain injury.

Case Description or Program Description: A 12-year-old male with no past medical history was struck by a car as a pedestrian, resulting in traumatic brain injury with an initial Glasgow Coma Scale of 8. He required intubation and imaging showed evidence of diffuse axonal injury, small right frontal lobe hemorrhage, and right frontal bone fracture. No surgical intervention was performed. After extubation and weaning sedation, he gradually returned to neurologic baseline. However, he was noted by clinical staff to speak with accented English, described as “Caribbean”. After admission to pediatric inpatient rehabilitation, his mother noted that this accent was new since injury.

Setting: Academic Medical Center, Inpatient Rehabilitation Unit

Assessment/Results: Detailed evaluation of the patient showed repetitive articulation errors, including gliding of the “r” phoneme to the “w” phoneme. Early and aggressive speech therapy in the inpatient rehabilitation setting focused on recognizing and correcting articulation errors. This produced improvement in the patient’s symptoms as early as the same week after diagnosis, and the patient became able to identify and self-correct the aberrant speech pattern. At approximately 2 weeks after discharge, the patient’s mother reported that the patient’s symptoms had resolved.

Discussion (relevance): Foreign accent syndrome (FAS) is an extremely rare complication of neurologic injury. This case represents only the second instance of pediatric FAS after traumatic brain injury.

Conclusions: The neurologic underpinnings of FAS are poorly understood. However, this case demonstrates that specific and consistent phonation changes resulting from neurologic injury can produce pathologic speech patterns which may be perceived as an accent. While FAS typically resolves within several months of injury, our case also suggests the potential for faster recovery in pediatric patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-case-of-foreign-accent-syndrome-as-a-sequela-of-pediatric-tbi/