SB is a 33-year-old, right-handed, monolingual French-speaking lady, originating from a village in the francophone Walloon part of Belgium near the Flemish border. She was raised in French and her parents were monolingual French-speaking Belgians. From a neurological perspective, growth and development were unremarkable. There was no family history of neurodevelopmental disorders or learning disabilities. She had always obtained normal school results and had an educational level of 12 years. She consulted the neurology department in November 2013 because of a "Dutch or German-like accent," which she acutely developed approximately 6 months after she was hit by a car while crossing the street to deliver orders from the bakery where she worked as a saleswoman. A few months after the accident occurred, the patient mentioned an "abrupt change of personality." She considered her behavioral change as the cause for her sudden dismissal at work. There had been serious disagreements with colleagues, customers, as well as with her line manager. She was dismissed in June 2012. It was shortly after her dismissal that she developed a foreign accent.
The accident happened in December 2011. There had been no loss of consciousness. Apart from some superficial subcutaneous hematomas in the frontal and right peri-orbital region, clinical examination on admission to the hospital was normal. CT scan of the brain and spinal cord were normal. A diagnosis of minor head trauma was made. One week later, the patient started suffering from increasingly painful headaches (possibly a post-traumatic migraine, see: Weiss et al.,) and a desensitization of the scalp. She complained of vertigo and was hospitalized for 3 days. The clinical neurological examination on admission was normal. Laboratory investigations (blood and urine), EEG and CT were normal as well. She was diagnosed with a post-concussion syndrome, benign paroxysmal vertigo (positive Hallpike test) and a cervical trauma. Approximately 1 month later the symptoms were still present. She identified several regions of hyperaesthesia and anesthesia in the facial area and the scalp. The vertigo had receded, but she complained of severe neck and shoulder pain. Approximately 4 months after the accident, she consulted a neurologist again. The clinical neurological examination and EEG revealed no abnormalities. During this visit, the patient mentioned that she felt she had become "someone else" after the accident, with regular aggressive outbursts toward family, friends, strangers, and clients. The patient complained about attention deficits and permanent fatigue. She also mentioned that the intensity of the accent was fluctuating: the accent was heavier when she was tired.
Due to the persistence of her complaints with respect to her accented speech and memory, the patient was referred to hospital for additional radiological examinations. In November 2012, she underwent a saggital T1-weighted and axial FLAIR, diffusion, SWI, proton density and T2-weighted MRI of the head, a coronal FLAIR MRI perpendicular to the axes of the left and right hippocampi, as well as an angio-MRI of the brain and 3D TOF of the circle of Willis. The qualified radiologist reported that all acquisitions were normal.
In November 2013, she consulted our department because of the persistence of the accent change and cognitive complaints (attention problems and episodes of confusion). At a linguistic level she suffered from word-finding difficulties and morphological problems related to article-noun agreement (she did not differentiate between the masculine and feminine forms of the definite article). According to her, listeners had the impression that she spoke with a Dutch accent. Her previous customers, for instance, had perceived her as a native Dutch-speaking Belgian and repeatedly asked her why she spoke French instead of "Flemish" (the Belgian variant of Dutch; see: Verhoeven,). She still suffered from behavioral changes and avoided social contact with her family and friends because of a lack of interest on her part. Yet, she was looking for more excitement in life, as well as a more frivolous, out-going lifestyle. She said she was deeply bored. In addition, a number of depressive symptoms were mentioned including apathy, loss of drive and initiative, and mood-swings.