Psychogenic or neurogenic origin of agrammatism and foreign accent syndrome in a bipolar patient a case report – rero doc anoxia at birth

Titre

• psychogenic or neurogenic origin of agrammatism and foreign accent syndrome in a bipolar patient: a case report

Auteur

• poulin, stéphane. Centre de recherche université laval robert-giffard, G1J 2G3, canada

• macoir, joël. Université laval, faculté de médecine, pavillon ferdinand-vandry, québec, (qc) G1K 7P4, canada

• paquet, nancy. Service de médecine nucléaire, rue wolfe, lévis (qc) G6V 3Z1, canada

• fossard, marion. Institut des sciences du langage et de la communication, chaire de logopédie II, faculté des lettres et sciences humaines, université de neuchâtel, switzerland

• gagnon, louis.


Service de médecine nucléaire, rue wolfe, lévis (qc) G6V 3Z1, canada

Type de document

• postprint

Date de publication

anoxia at birth

• 2007

Langue

• anglais

Publié dans

• annals of general psychiatry, 2007, vol. 6, no. 1, p. 1-13. BioMed central

Autre version électronique

• published version : http://dx.Doi.Org/10.1186/1744-859X-6-1

Classification

• orthophonie

Identifiant OAI-PMH

• oai:doc.Rero.Ch:20120210115644-AX

Numéro de soumission

• 20120210115644-AX

Summary

Background

Foreign accent syndrome (FAS) is a rare speech disorder characterized by the appearance of a new accent, different from the speaker’s native language and perceived as foreign by the speaker and the listener. In most of the reported cases, FAS follows stroke but has also been found following traumatic brain injury, cerebral haemorrhage and multiple sclerosis. In very few cases, FAS was reported in patients presenting with psychiatric disorders but the link between this condition and FAS was confirmed in only one case.Anoxia at birth

Case presentation

In this report, we present the case of FG, a bipolar patient presenting with language disorders characterized by a foreign accent and agrammatism, initially categorized as being of psychogenic origin. The patient had an extensive neuropsychological and language evaluation as well as brain imaging exams. In addition to FAS and agrammatism, FG also showed a working memory deficit and executive dysfunction. Moreover, these clinical signs were related to altered cerebral activity on an FDG-PET scan that showed diffuse hypometabolism in the frontal, parietal and temporal lobes bilaterally as well as a focal deficit in the area of the anterior left temporal lobe. When compared to the MRI, these deficits were related to asymmetric atrophy, which was retrospectively seen in the left temporal and frontal opercular/insular region without a focal lesion.Anoxia at birth

Discussion

To our knowledge, FG is the first case of FAS imaged with an 18F-FDG-PET scan. The nature and type of neuropsychological and linguistic deficits, supported by neuroimaging data, exclude a neurotoxic or neurodegenerative origin for this patient’s clinical manifestations. For similar reasons, a psychogenic etiology is also highly improbable.

Conclusion

To account for the FAS and agrammatism in FG, various explanations have been ruled out. Because of the focal deficit seen on the brain imaging, involving the left insular and anterior temporal cortex, two brain regions frequently involved in aphasic syndrome but also in FAS, a cerebrovascular origin must be considered the best explanation to account for FG’s language deficits.Anoxia at birth