Foreign accent syndrome (FAS) is a rare condition involving speech output that usually occurs subsequent to cerebrovascular injury. Articulatory distortions of the native language are perceived as foreign/dialectical by others of the region.

This report considers a case of FAS during two distinct periods of mania without evidence of cerebrovascular injury. The case provides a detailed explanation of the patient's history, course, speech and neuropsychological testing patterns.

To describe in the literature the first case of mania-induced FAS.

This case study was detailed retrospectively, providing a thorough psychiatric and medical history, formal neuropsychological testing, and speech analysis of baseline and exacerbation periods via voice recordings.

The patient displayed two distinct episodes of FAS only present during mania. Due to signs of limited effort, as well as potential effects of anxiety on performance, neuropsychological testing reflected inconsistent findings irreconcilable with any particular diagnostic pattern. Speech samples from both exacerbation and recovery periods parsed for comparison showed excess-equal stress, and consonant-vowel distortions when symptomatic. Elevated fundamental frequency, higher intensity, decreased speech intelligibility, and faster rate of speech were produced during exacerbation. No significant medical abnormalities were revealed by laboratory, CT scan or physical exam results.

As the patient had no history of cardiovascular or cerebrovascular disease, negative medical workup, negative brain imaging, and neuropsychological testing failing to demonstrate an etiology for the FAS exacerbation, we conclude the patient's FAS was a result of mania. Speech analysis also supported this theory.