The teenager regained consciousness after surgery and was able to communicate exclusively in English, his second language. (Image credit: mediaphotos/Getty Images)
Patient: 17-year-old boy from the Netherlands.
Symptoms: The boy was admitted to a hospital in the Netherlands for surgery on a knee he sustained in a football game. The surgery was successful, but when he regained consciousness after anesthesia, he spoke only English and “repeatedly” claimed to be in the United States. Before this incident, he had only used English in school lessons.
He did not recognize his parents and could not speak or understand spoken Dutch, which was his native language. According to information provided by doctors, the patient had no history of psychiatric symptoms and no significant medical history in the family, except for some cases of depression on the maternal side.
What happened next: The nurse who first noticed the patient speaking English was initially unconcerned, thinking the teenager was becoming delirious — a state of confusion that can occur when coming out of anesthesia. However, when, hours later, the medical staff were unable to get the patient to utter a word of Dutch, they called in a psychiatric consultation.
The psychiatric team found the patient relaxed and attentive. He was able to answer questions, albeit in English with a Dutch accent. Later, he began to give short answers in Dutch, but this was difficult for him.
Diagnosis: A 17-year-old boy was diagnosed with foreign language syndrome (FLS), which occurs when patients suddenly and involuntarily switch to using a second language instead of their native language for a period of time.
Treatment: The neurologist found no abnormalities during the patient's full neurological examination. Then, 18 hours after the operation, the young man could understand Dutch, but still could not speak it. Some of his friends visited him the day after the operation, and suddenly he could understand and speak Dutch again.
Because the teenager spontaneously returned to his native language, doctors found no need to perform neuropsychological tests, electroencephalograms (EEGs), or other types of brain imaging. He was discharged three days after surgery.
What makes this case unique: FLS is rare, with only about nine cases reported in the medical literature. Most of these cases were white males who were switching from their native language to another language learned later in life; they were generally not bilingual as children. The race of the patients was not specified in two cases.
The authors of the case report noted that FLS is extremely rare in children and suggested that they were the first to formally document a case of FLS in a teenager. In total, they found eight reported cases of FLS similar to their patient's, in which the sufferers switched to an entirely different language rather than speaking with an accent.
This is different from another condition, foreign accent syndrome, in which people adopt a speech pattern that sounds like they have an accent. This rare condition often, but not always, occurs after traumatic brain injury.
The causes of FLS are not fully understood, although there have been cases where the syndrome has occurred after anesthesia. The authors of the report noted that the effects of anesthetics on cognitive functions, as well as the removal of anesthetic substances from the central nervous system, can lead to the development of delirium. For this reason, they are not sure whether FLS can be considered a separate condition or just a type of delirium.
Disclaimer
This article is for informational purposes only and does not constitute medical advice.
TOPICS Diagnostic Dilemma
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