A man developed foreign accent syndrome (FAS) as a rare and perhaps unique manifestation of his prostate cancer, his doctors have described in a BMJ Case report.
The case describes how a man, in his 50s, was diagnosed with prostate cancer 20 months prior to his speech issues. At that point, he reported notable changes to his usual speech patterns, in that he had begun to speak with an "Irish brogue" accent.
"The patient had never been to Ireland and had never previously spoken in an Irish accent, though he had Irish family/friends and had lived in England briefly in his 20s," the team wrote of the man, who lived in California. "His accent was uncontrollable, present in all settings and gradually became persistent."
The patient told doctors that he had not suffered any head trauma, nor any other symptoms beyond unintentional weight loss. An MRI of his brain came back as normal, but a CT scan of his pelvis and abdomen revealed that his prostate cancer was progressing. As well as being diagnosed with FAS, he was referred to neurology for further investigation.
FAS is extremely rare, with only around 100 people in the world having been diagnosed with the strange condition. Most cases have occurred following traumatic injury to the head or a stroke, resulting in damage to the areas of the brain responsible for speech. Often, the condition is not permanent and will go away, for example as the sufferer recovers from a stroke.
Though called foreign accent syndrome, the condition is not really giving somebody a new inexplicable accent. The change in sounds produced by people with the condition is often likely caused by altered movements of the patient's jaw and tongue. The foreign accent is likely only really in the mind of the people who hear it, a form of pareidolia.
Three months later, receiving treatment for his cancer, the patient was still speaking in an Irish accent. As well as this, he had developed abdominal and leg pain. When the team scanned him, they found the cancer had spread to his liver and bones. The cancer progressed further, metastasizing to his brain.
The team believe his foreign accent syndrome was caused by paraneoplastic syndrome, given that it can be associated with prostate cancer, and that the progression of his FAS coincided with the progression of the cancer. Paraneoplastic syndromes, the team write, are systemic symptoms caused by abnormal masses "through hormonal, immune-mediated or unknown mechanisms".
The team believe that this is the first case reported in the medical literature of FAS as the result of prostate cancer, though there have been two others reported in patients with other malignant cancers. The team hopes that the case highlights the need for more literature on FAS and paraneoplastic syndromes in cancer patients, to better understand the link between the rare syndromes.
As for the patient, the man died under palliative care, with the team noting "his Irish brogue-like accent was maintained until his death".
The case report was published in BMJ Case Reports.