Table 1 Summary of cases of foreign language syndrome
Author | Demographics | Type of surgery | Administered medications | Native language (L1) | Second language (L2) | Outcome | Notes | Author theory/conclusion |
|---|---|---|---|---|---|---|---|---|
Webster [5] | 55-year-old Caucasian male (New Zealand) | Pharyngoscopy, inversion of the pouch, and a cricopharyngeal myotomy | Premedication: - Midazolam 2 mg Anesthesia - Propofol 3 mg/kg - Rocuronium 1.2 mg/kg Analgesia: - Intermittent boluses of fentanyl (up to a total dose of 1.5 μg/kg) Prophylactic: - Augmentin 1.2 g | English | - Spanish (working knowledge) - Started learning at the age of 37 years - Spoken yearly due to his visits to Chile | - Initially Spanish speaking; understood English and Spanish - Recovered English-speaking ability in 1 hour after sleeping | - Recalled the event and the frustration of not being able to think of an English reply - Did not remember any specific details of what he said in Spanish | - Native and non-native languages are stored in spatially separate areas in the brain - Anesthetics affect the areas differentially, so one language faculty remains active while the other is inactive - Hypoglycemia could be associated - In this case, unclear whether the patient was hypoglycemic at the time of his transient fixation episode |
Pollard [6] | 64-year-old Caucasian male (from USA) | Bladder cancer presented for radical cystectomy | - Opioid for pain control. Anesthesia: - Propofol (maintained with volatile agents and fentanyl) | American English | Norwegian | - Norwegian Speaking only postoperative - Recovered English-speaking in 5 hours | - Assumption that the event transiently affected L1 area of the brain (English) and spared L2 region (Norwegian) - Only males; possible explanation is lateralization of languages in males (left-dominant activation) | |
Ward [18] | 54-year-old Caucasian male (England) | Arthroscopic surgery for medial meniscectomy | Premedication: - Ranitidine 150 mg - Metoclopramide 10 mg Anesthesia: - Midazolam 2 mg - Propofol 180 mg - Fentanyl 75 mg Other: - Diclofenac suppository 100 mg (inserted rectally) | English | Spanish | - Initially Spanish speaking - Recovered English-speaking once glucose replenished | - No recall of speaking Spanish - Second time speaking Spanish after surgery with general anesthesia - Denied being able to speak it any longer | Suppression of a mother tongue leading to the release of acquired language Possible explanations: - Hypoglycemia: a temporal lobe seizure was induced by hypoglycemia and postictal period speech was depressed, allowing the learned speech to emerge - Anesthesia, resulting in significant cerebral insult - Parapsychology |
Cosgrove [19] | Male in his 70s, undocumented race | An open reduction and internal fixation of a fractured tibia | - Fentanyl - Propofol | English | Hindi (learned some phrases in army during World War II) | During the induction, when counting aloud to 30, he began in English and then continued in Hindi | Denied being able to remember or speak Hindi | Language switching due to general anesthesia |
Akpek [20] | 68-year-old Caucasian male (Czechoslovakian, living abroad) | Unknown | Czechoslovakian | English | - Did not understand English commands - Recovery time not documented | - Main language is primarily stored in “implicit memory systems” of the subcortical regions - Acquired languages stored more diffusely in the cerebral cortex - The role of anesthesia is not yet understood | ||
Male of undocumented race and age (from Turkey, lived in USA) | Unknown | Turkish | English | - English-speaking only postoperative - Recovered speaking Turkish within 24–28 hours | ||||
Yulia Ivashkov [21] | 52-year-old Caucasian male | Elective ankle osteotomy for a malunited tibial fracture | English | French (learned some from his mother who was a native French speaker) | French speaking postoperatively, recovered English-speaking in 1 hour | - Did not recall speaking French during his recovery from anesthesia - Remembered his frustration when everybody was “speaking Russian” and not being able to understand - This was possibly a mistake due to hearing an anesthetist speaking English with a Russian accent | Speech suppression could either (a) be produced by anesthetic agents or (b) be a consequence of other cerebral events of an ischemic nature (embolic or otherwise) | |
28-year-old Caucasian male | Right orbital floor blowout fracture was undergoing a fracture repair | - Midazolam - Fentanyl - Propofol - Rocuronium - Maintained with sevoflurane | English | Spanish (studied in primary school but had never used it) | - Understood English and could follow commands but responded in Spanish - Recovered in 25 minutes postoperation | - Had had several similar episodes of conversion to Spanish in the past during occasions of severe alcohol intoxication - The intoxication events had required an emergency medical response, and the medical personnel had noted that he had spoken fluent Spanish during these episodes | ||
Our case | 17-year-old Caucasian male (the Netherlands) | Cartilage repair lateral femoral condyle right | Anesthesia during surgery: - Sufentanil 35 mcg - Morphine 4 mg - Propofol 290 mg + propofol 928 mg 10 mg/ml - Cefazoline 1000 mg - Efedrine 7.5 mg - Paracetamol 1000 mg - Dexamethasone 4 mg - Ondansetron 4 mg - Tranexamic acid 375 mg - Ringer’s lactate 1000 ml | Dutch, southern dialect (Limburgish) | English (acquired in a nonbilingual school during regular English classes) | - Initially English-speaking and did not understand Dutch postoperatively - Recovered English-speaking after 24 hours | In the beginning, was confused and was unaware he was speaking a non-native language | FLS as phenotype of ED |