PARADOXICAL FACILITATION: THE RESOLUTION OF FOREIGN ACCENT SYNDROME AFTER CEREBELLAR STROKE

• DOI: 10.1212/wnl.0b013e3181b2a4d8
• Publication Date: 2009-08-17T20:27:27Z
• Authors: D. A. Cohen; K. Kurowski; M. S. Steven; S. E. Blumstein; A. Pascual-Leone
• Keywords: Paresis; Cerebellar ataxia; Diaschisis; Stroke

Foreign accent syndrome (FAS) is a rare speech disorder characterized by change in prosody and other variables yielding altered phonetic characteristics that are perceived as foreign accent. Lesions associated with FAS typically involve left frontoparietal regions. However, 2 reported left-hemispheric stroke patients presenting also had hypoperfusion of the right cerebellum on 99mTc ECD SPECT imaging, presumably from diaschisis. In both cases, there was close parallel between normalization cerebellar perfusion resolution clinical up to 3 years later despite continued hemispheric structures.1,2 The authors argued temporal association improvement suggested functional role this disorder. We describe unique case provides convergent evidence for causative FAS.

### Case report.

A right-handed English-speaking woman 58 age at time her infarct (figure, A), upper limb paresis aphemia. Within hours, patient’s resolved slight hand ataxia sounded like English spoken an unlearned Workup embolic event, she discharged warfarin. persisted approximately until inferior hemorrhage B–D) accidental excessive anticoagulation. Following second stroke, patient family noted no longer perceptible speech. …