A man with cancer woke up to find he suddenly had an Irish accent, even though he had never been to the country.
The American had been battling an advanced form of prostate cancer for almost two years before seeking advice for his ‘uncontrollable brogue’.
Doctors diagnosed the man in his 50s with the extraordinarily rare foreign accent syndrome (FAS).
It means that he is only one of the few people to have ever experienced the speech disorder, which usually occurs as a complication of a stroke or head injury.
But doctors in North Carolina, who treated him and shared clips of his voice before and after the strange change, believe his cancer was to blame. He later he died.
The American had been battling an advanced form of prostate cancer for almost two years before seeking advice for his ‘uncontrollable brogue’. Pictured, Classiebawn Castle, Mullaghmore, Sligo
The man in his 50s had been battling an advanced form of prostate cancer for almost two years before seeking advice for his ‘uncontrollable brogue’. Pictured above, MRI images released by doctors at Duke University Health System of the man’s brain. A-scans are T2-weighted images, while B-scans are fluid-attenuated inversion recovery images
Presenting your case at the Case reports from the British Medical Journalthe Duke University Health System team said they believe the man had developed a paraneoplastic neurological disorder (PND).
Foreign accent syndrome: what do we know?
Foreign accent syndrome is a rare disorder that causes the patient to speak with an accent different from their natural style of speaking.
It is usually the result of an injury to the head or brain, with strokes being the most common cause.
FAS can also occur after trauma to the brain, bleeding in the brain, or a brain tumor. Other causes, such as multiple sclerosis and conversion disorder, have also been reported.
It has only been recorded 150 times worldwide since its discovery in 1907.
FAS has been documented in cases around the world, including accent changes from Japanese to Korean, British English to French, and Spanish to Hungarian.
It causes patients to pronounce vowels in different ways, move their tongue and jaw differently when speaking to produce a different sound, and even substitute words they don’t normally use.
In some cases no clear cause has been identified.
Foreign accent syndrome can last for months or years, or sometimes it can even be permanent.
These are rare complications of cancer, caused by disease-fighting cells of the immune system mistakenly attacking the nervous system.
This usually causes problems with muscle coordination or movement, but it can also affect thinking skills and memory.
The man, who was not identified, was being treated at ‘an outside institution’ for prostate cancer that had spread through his body.
Over the course of 20 months, he had received androgen deprivation therapy: a hormonal therapy to suppress or block the production or action of male hormones, as well as radiation therapy.
Concerned by her sudden change, the man revealed that he had never been to Ireland and had never spoken with an Irish accent before.
However, he told doctors that he had Irish family and friends and had briefly lived in England when he was 20 years old.
Doctors said her new accent was “uncontrollable, present in all settings, and gradually became persistent.”
Prior to his speech change, he also had no known head injury and had not suffered from any psychiatric conditions.
Although she had unintentionally lost weight, she reported no other symptoms.
The results of an MRI of the brain also showed no abnormalities, ruling out the usual causes of foreign accent syndrome.
But a CT scan of the abdomen and pelvis revealed that his prostate cancer had spread further, with “a new set of right pelvic lymph nodes over the bladder.”
Due to his progressive prostate cancer, he was referred to the Duke Cancer Institute three months later for further treatment.
At this point, the man was still constantly speaking in the ‘Irish brogue’ accent, the doctors noted.
But his cancer had turned into neuroendocrine prostate cancer (NEPC), a deadly variant of prostate cancer.
According to doctors, there are many known cases of PND presenting as symptoms of NEPC patients.
In the UK, prostate cancer is the most commonly diagnosed cancer. One in eight men will be diagnosed with the disease in their lifetime, charities say.
However, the current outlook for patients with advanced prostate cancer is poor, and few treatment options are available.
Some 12,000 men die each year from the disease in the UK, 33 every day, with almost 35,000 deaths each year in the US.
Doctors wrote that the man was shortly transferred to hospice care at home, due to his “rapid clinical deterioration” as his cancer progressed despite chemotherapy.
He passed away “shortly after,” they said.
“His brogue Irish accent was carried on until his death,” they wrote in the BMJ publication.
Foreign accent syndrome can also occur after trauma to the brain, bleeding in the brain, or a brain tumor.
Only around 150 cases have been documented worldwide since its discovery in 1907.
It differs from foreign language syndrome. The condition occurs when people suddenly forget to speak their first language and rely on a second language instead. This may be a language they haven’t spoken for years.
WHAT IS PROSTATE CANCER?
How many people does it kill?
More than 11,800 men a year, or one every 45 minutes, die from the disease in Britain, compared with about 11,400 women who die of breast cancer.
It means that prostate cancer trails only lung and intestine in terms of how many people it kills in Britain.
In the US, the disease kills 26,000 men each year.
Despite this, it receives less than half the funding for breast cancer research, and treatments for the disease are lagging behind by at least a decade.
How many men are diagnosed annually?
Every year, more than 52,300 men are diagnosed with prostate cancer in the UK, more than 140 every day.
How fast does it develop?
Prostate cancer usually develops slowly, so there may not be any signs of someone having it for many years, according to the National Health Service.
If the cancer is found at an early stage and is not causing symptoms, a “watchful waiting” or “active surveillance” policy may be adopted.
Some patients can be cured if the disease is treated in the early stages.
But if it is diagnosed at a later stage, when it has spread, then it becomes terminal and treatment revolves around relieving symptoms.
Thousands of men refuse to seek a diagnosis due to the known side effects of the treatment, including erectile dysfunction.
tests and treatment
Testing for prostate cancer is randomized, and the precise tools are only just beginning to emerge.
There is no national prostate screening program as the tests have been too inaccurate for years.
Doctors have difficulty distinguishing between aggressive and less serious tumors, making treatment decisions difficult.
Men over the age of 50 are eligible for a ‘PSA’ blood test which gives doctors a rough idea of whether a patient is at risk.
But it is not reliable. Patients who test positive are usually given a biopsy, which is also not foolproof.
Scientists aren’t sure what causes prostate cancer, but age, obesity, and lack of exercise are known risks.
Anyone with concerns can speak to the specialist nurses at Prostate Cancer UK on 0800 074 8383 or visit cancerdeprostate.org
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