202 - Foreign Accent Syndrome in a Pediatric Patient with Acute Disseminated Encephalomyelitis (ADEM): A Case Report

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CR

Casey Roark, MD

Resident Physician
UAB
Gardendale, AL, Alabama, United States

Co-Author(s)

KC

Kelli N. Chaviano, DO

Assistant Professor, Physician
UAB/COA
Birmingham, Alabama, United States

Submitter(s)

CR

Casey Roark, MD

UAB
Gardendale, AL, Alabama, United States

Case Diagnosis: Foreign Accent Syndrome (FAS) secondary to Acute Disseminated Encephalomyelitis (ADEM) in a pediatric patient.

Case Description: A 16-year-old girl with ADHD presented with somnolence, paresthesias, encephalopathy, and gait instability following a Mycoplasma infection. Brain MRI revealed multifocal T2/FLAIR hyperintensities in the bilateral cerebral hemispheres and brainstem, consistent with ADEM. She was treated with a five-day course of high-dose intravenous steroids followed by an oral taper and admitted to inpatient rehabilitation. As her cognition improved, she progressed from speaking only short phrases to producing speech with a distinct prosody described by her family as a “Polish accent.” Her accent resolved within a week, accompanied by continued improvements in gait, balance, swallowing, and impulsivity.

Discussions: Foreign Accent Syndrome is a rare speech condition in which changes in speech patterns give the impression of a foreign accent. It is most often described after stroke but has also been reported in traumatic brain injury, seizures, migraines, functional neurological disorder, and psychiatric illness. While rare developmental cases have been described, there are no studies highlighting acute occurrence in the pediatric population. To our knowledge, this is the first case to document the occurrence of FAS in the setting of ADEM.

Conclusions: This case adds to the limited literature on Foreign Accent Syndrome by documenting both its occurrence in ADEM and in a pediatric patient. For physiatrists, it reinforces the importance of maintaining vigilance to unique neurologic presentations that may emerge early in recovery. Awareness of FAS can provide more nuanced guidance regarding expectations and potential prognosis throughout their rehabilitation care.