Italian woman's rare 'foreign accent syndrome' caused her to sound Canadian

A woman in Italy who went to the emergency room experienced a puzzling symptom: She suddenly began speaking in a Canadian accent even though her native language was Italian, according to a new report.

The woman was diagnosed with an extremely rare disorder known as foreign accent syndrome (FAS), a condition in which a person develops a sudden change in their speech that makes them sound like they are speaking with a foreign accent. Only about 150 cases have ever been reported since the condition was first described in 1907, according to the new report, published Jan. 22 in the journal Neurocase. 

Most often, the condition is related to brain damage associated with conditions such as a stroke or traumatic brain injury. But the woman's case was unusual because no such damage could be found.

The 50-year-old woman went to the emergency room when she suddenly began experiencing difficulty speaking and writing, as well as slurred speech that lasted about five minutes, according to the report. After this episode, doctors noticed that the woman's speech was normal but she had started speaking with a Canadian-like foreign accent in both her native Italian and in English, her second language. (She learned English at school beginning at age 10 and later through her work in English-speaking countries, the report said.)

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One distinct trait of her new accent was "Canadian raising," a feature of Canadian English that changes the pronunciation of certain vowel sounds known as diphthongs — for example, the "ou" sound in "house" and "about." The woman had worked with colleagues in Canada for 20 years, and these colleagues told her doctors that her new accent was typical of their region.

At the hospital, the woman underwent several brain scans, but the results showed no signs of brain injury. The week before her hospital admission, she had tested positive for COVID-19, but by the time she arrived at the hospital, she tested negative.

The report authors, from the Carlo Besta Neurological Institute in Milan, more thoroughly investigated the possible causes of the woman's foreign accent syndrome with additional brain imaging and cognitive and psychiatric tests. For example, they examined the woman's brain activity while she performed certain tasks, certain tasks, in both English and Italian, that were intended to activate parts of the brain involved in speech production and language processing. For example, one task, known as a "verb generation task," typically involves asking the subject to come up with action verbs that are related to a specific noun.

These brain imaging tests did not reveal anything unusual; the woman's brain activity patterns appeared typical of a healthy, bilingual adult. Her psychiatric test results were also mostly in the normal range, except for slightly high levels of anxiety. In addition, the patient had high scores on a measure of obsessive-compulsive personality disorder (OCPD), a mental health condition in which people have a preoccupation with rules, orderliness and control, and have symptoms of perfectionism, according to the National Institutes of Health.  

This condition is different from obsessive-compulsive disorder (OCD), in that the latter is an anxiety disorder characterized by recurring, unwanted thoughts (obsessions) that lead people to perform repeated behaviors (compulsions), while the former is a personality disorder (involving personality traits) in which people are excessively focused on details, order and control, according to the Cleveland Clinic. The questionnaire the patient took doesn't necessarily provide enough information for her to be diagnosed with OCPD, but it is one factor doctors consider.

The researchers can't be sure what caused the woman's foreign accent syndrome, but there are a few possibilities. Given that she did not show signs of brain damage or unusual patterns of brain activity, it's possible that the condition was caused by psychological factors, the authors said. A small number of cases of FAS have been tied to psychological or psychiatric conditions, such as schizophrenia, bipolar disorder, OCD, anxiety, depression and post-traumatic stress disorder (PTSD), according to the report. These cases are referred to as "psychogenic" FAS because psychological conditions, rather than brain damage, are suspected to play a role.

Still, the authors cautioned that they can't rule out a neurological cause, such as microscopic brain lesions that did not show up on the brain imaging. In addition, COVID-19 is known to be tied to brain problems — including symptoms of fatigue, "brain fog," headaches, and loss of taste and smell — and has even been linked with brain shrinkage. Interestingly, at least two cases of FAS, one from Italy and another from Japan, have been linked with COVID-19. So it's possible that the woman's recent SARS-CoV-2 infection played a role in the development of FAS, the authors said.

The woman's Canadian-like accent remained after she was discharged from the hospital, and she said she could only modulate it slightly, according to the report. Eight months later, the researchers followed up with the woman and conducted more tests. But their findings were the same, and the woman's accent remained strong and distinct, though she reported being able to modulate it more consistently with people she knew, the authors said.