When Karen Butler went in for dental surgery, she left with more than numb gums: She also picked up a pronounced foreign accent. It wasn't a fluke, or a joke — she'd developed a rare condition called foreign accent syndrome that's usually caused by an injury to the part of the brain that controls speech.
Butler was born in Bloomington, Ill., and moved to Oregon when she was a baby. She's never traveled to Europe or lived in a foreign country — she's an American, she says, "born and bred."
But she doesn't sound like one anymore. Her accent is now a hodgepodge of English, Irish and perhaps a bit of other European accents.
The problem started about a year and a half ago, when she was put under anesthesia while the dentist removed several teeth.
"I just went to sleep and I woke up and my mouth was all sore and swollen, and I talked funny. And the dentist said, 'You'll talk normal when the swelling goes down,' " Butler says.
The swelling soon went away, but the foreign accent didn't. Neurologist Ted Lowenkopf, director of the Providence Stroke Center in Portland, diagnosed her with foreign accent syndrome, a rare neurological disorder.
"It's usually the result of a brain injury," Lowenkopf says, "which can come from stroke, head trauma or other diseases that can damage brain tissue, like multiple sclerosis."
There have been only about 100 known cases of the syndrome since it was first reported in the 1940s. The most famous case was a Norwegian woman who was hit by shrapnel in World War II; she developed a German accent and was ostracized as a result.
Lowenkopf says FAS affects only a small area of speech — just the pattern and intonation. Strokes and brain trauma usually cause major damage to the brain and leave people with far bigger speech problems than just a change in accent.
Butler may have suffered a small stroke while she was under anesthesia, but she won't know for sure unless she has a brain scan. (She says her insurance company won't pay for one.) Lowenkopf says comparing an old scan that Butler received years ago to a new one could shed some light on what happened.
In the meantime, it's possible that Butler could get her American accent back through intensive speech therapy. But unlike other people with FAS who have become depressed by their change in accent, Butler quite likes her new one. She says it has made her more outgoing and is a good conversation starter.
MARY LOUISE KELLY, host:
It's not unusual for people who suffer a stroke or any sort of brain injury to have trouble with their speech. But what happened to a woman in Oregon is very unusual. She was put under anesthesia during dental surgery and she woke up speaking with an accent. As NPR's Jane Greenhalgh reports, it's a rare condition called Foreign Accent Syndrome.
JANE GREENHALGH: First of all, I need to point out I've had my accent all my life. That's not the case for Karen Butler.
Ms. KAREN BUTLER: I was born in Bloomington, Illinois but I moved to Oregon when I was a little, tiny baby and I've been in Oregon ever since.
GREENHALGH: With the exception of a couple of trips to Mexico and one to Canada, Karen Butler has never been out of the United States, never traveled to Europe, never lived in a foreign country.
Ms. BUTLER: I'm an American - born and bred.
GREENHALGH: And she used to sound like one.
(Soundbite of answering machine message)
Ms. BUTLER: Hi, this is Karen. Sorry I can't come to the phone at the moment. Just leave me a message and your phone number and I'll get back to you. Thank you.
GREENHALGH: Karen's problems started about a year and a half ago when she had to have dental surgery. She was put under anesthesia while the dentist removed several teeth.
Ms. BUTLER: I just went to sleep and woke up and I thought my mouth is all sore and swollen and I talk funny. And he said it will all go away. You'll talk normal when the swelling goes down - and then I didn't.
GREENHALGH: In fact, the strange accent lasted for more than a month before she was finally diagnosed. Neurologist Ted Lowenkopf is director of the Providence Stroke center in Portland. He ran some standard neurological tests on Butler.
Dr. TED LOWENKOPF (Neurologist, Director of Providence Stroke Center): The pattern of her speech is foreign to what she spoke previously, and to my ear sounds like some sort of hybrid of English accent, some Irish or Gaelic intonations, and even some Scottish flavor - but it's consistent.
GREENHALGH: Lowenkopf thinks Karen Butler has Foreign Accent Syndrome.
Dr. LOWENKOPF: Foreign Accent Syndrome is an extremely rare neurologic condition where, as a result of brain injury which can come from stroke or from head trauma or other from diseases that can damage brain tissue like multiple sclerosis, a person as a result has an altered speech pattern that sounds like a foreign accent.
GREENHALGH: Lowenkopf suspects that Butler suffered a small stroke while she was under anesthesia which caused damage to the area of her brain which effects speech.
Dr. LOWENKOPF: This a very small selective injury to an area of the brain, very rare because of how small and selective it is, that effects just the intonation and syncopation of speech.
Ms. BUTLER: H and R Block, Newport, this is Karen...
GREENHALGH: Researchers have documented a variety of accents, caused by this condition...
Ms. BUTLER: What is your name?
GREENHALGH: ...Japanese, Hungarian, Scandinavian. The most famous case was a young woman in Norway who was hit by shrapnel during World War II. She unfortunately developed a German accent and was ostracized as a result. Other cases include a British woman from Devon who now speaks like she's Chinese. Butler says it's a difficult condition for her to explain to people.
Ms. BUTLER: They don't understand that you can't talk a foreign language I can't understand Russian or anything else. Someone asked me about bangers and chips and I don't even know what bangers are.
Ms. BUTLER: Oh, sausages.
GREENHALGH: Butler would like to get a brain scan but she says her insurance company won't pay for it. She had one several years ago following a small seizure and she thinks if doctors compared a new brain scan to her old one, it could reveal the cause of her strange accent. Lowenkopf agrees.
Dr. LOWENKOPF: It would be very interesting to see the before and after picture, because if there had been a focal brain injury you would see an area of injury and say here is something to add to the medical literature in understanding Foreign Accent Syndrome.
GREENHALGH: Karen Butler could possibly get her American accent back with intensive speech therapy, but she quite likes it. Unlike other suffers who become depressed over their change in speech, Karen Butler says it's made her more outgoing.
Jane Greenhalgh, NPR News, Portland, Oregon. Transcript provided by NPR, Copyright NPR.