When Karen Butler came out of sedation after oral surgery a year and a half ago, her mouth throbbed and her face was puffy. But that's not all that had changed. When she spoke, the words tumbled out in a thick and foreign accent.



"I sounded like I was from Transylvania," she said.



Over the next few days, the swelling subsided and the pain vanished, but Butler's newly acquired accent did not. Though it has softened over time, she's never again spoken like a native Oregonian from Madras. To most people, she sounds British.



It took months to find an explanation: foreign accent syndrome, a disorder so rare that only about 60 cases have been documented worldwide since the early 1900s.



She's the first known case in Oregon, said Dr. Ted Lowenkopf, medical director of the statewide Providence Stroke Center.



The condition changed Butler's life, forcing her to answer endless questions about her accent. Most people are incredulous at first. A few insist she's faking it.



Foreign accent syndrome is usually caused by a stroke, though it also has been associated with multiple sclerosis, head injuries and migraines.



One of the first cases was reported at the turn of the last century by a French neurologist. But the best known case, documented by Norwegian neurologist Georg Herman Monrad-Krohn, was a 30-year-old woman, who was hit by shrapnel from a German air raid over Oslo in 1941. The injury left her with a speech impairment that gradually improved, turning into what sounded like a German accent to her countrymen. Suspecting that she was a collaborator, they ostracized her.



"When it first happened and we didn't know what it was, all kinds of ideas were handed up as possibilities," said Butler, a 56-year-old mother of five. Her family joked that she had spun into a past life regression.



She sought help from her dentist and family physician. Both figured the dentures put in during surgery had caused the change.



She felt that wasn't the case. But in the weeks after the operation at the end of November 2009, she focused on Christmas and then it was January. Manager of an H&R Block office in Newport, she became swamped in work.



In May, when tax season died down, she consulted a neurologist in the Corvallis area. After some research, he came up with the diagnosis.



Lowenkopf, who just met Butler last week, said the syndrome remains much of a mystery. Although he read about it in his neurological training, he had never encountered it before in real life.



"I'm amazed by it, and intrigued by it," he said.



It's unclear what caused her speech pattern to change. Dental surgeries do not pose a stroke risk and the drug that Butler says the dentist used to sedate her -- Halcion -- has not been linked to strokes.



Her dentist, Gregory Herkert, did not want to comment.



Lowenkopf said the syndrome has been linked to injuries in different areas of the brain -- the left frontal lobe, the right side and the cerebellum, a "little brain" tucked back on the bottom. The damage is almost always very small, which is why the syndrome is so rare. Strokes usually involve a bigger injury with a bigger impact, depriving a patient of the ability to speak intelligibly, for example, or to understand others.



"What happens with foreign accent syndrome to the best of our understanding is that a very, very small part of the speech area is affected so that the normal intonation of speech gets altered," he said.



He believes that patients adapt, making them sound to others as if they have an accent.



She would like to have a brain scan -- to compare with one she had years ago -- but can't afford it and her insurance won't shell out the money. Tests show she has no physical problems.



Everything works," she said, "It just works odd."



She and her family have taken the change in stride, even delighting in it.

Stroke signs

Remember F-A-S-T if you suspect someone's having a stroke:

Face

- Does the person have a facial droop? Ask them to smile.

Arms

- Is on arm weak or numb? Ask the person to raise both arms.

Speech

- Is the speech slurred? Ask the person to repeat a simple sentence.

Time

- Time for help. Call 9-1-1!

"This is not a tragedy," said her husband, Glen Butler, a retired Coast Guard official. "The only thing that changed was her voice. She's still her."



She doesn't even hear her new accent -- unless she watches herself on a video.



"I'm very lucky it was not something that was devastating," she said. "On a scale of one to 100 this doesn't even come up to a one."



Like many others diagnosed with the condition, she's never been to the country her accent seems to stem from, though she did study German in eighth-grade and does collect teapots -- but from America.



"Although Mrs. Butler has never been to England and has no English relatives as far as we know, I'm sure she's heard an English accent," Lowenkopf said.



Other native English language speakers with the syndrome have sounded Russian, Chinese, German, Spanish, Jamaican and Italian. But none of the accents is pure, linguists say. Listen closely and you'll hear a mix of sounds caused by the way people produce consonants and vowels or emphasize certain syllables, making them sound foreign.



William F. Katz, professor of communication disorders at the University of Texas at Dallas, has studied a number of patients since 1987 in his speech lab.



"We want to understand the circuits that underlie it and what we can do to fix it," he said. "It's kind of puzzling. Sometimes patients get very frustrated."



His lab's recent attempt to retrain the speech patterns of a Dallas woman who was often mistaken for being Swedish failed, but he said she had other medical issues.



Butler doubts she could be retrained to speak like an Oregonian again. "Others can pretend to talk in different ways," she said. "I can't. That's gone."



Gone, too, is her shyness. Before the surgery, she was painfully shy.



No longer.



"Before I was just an ordinary person," she said. "Now everybody is intrigued. They want to know where you're from. So I've learned in the last year that it's OK to be social. I like it actually."

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