Cindy Langdon spent the weekend in bed. She felt nauseous, and the words tumbling out of her mouth had nothing to do with what she was trying to say. It was frightening. And before this Memorial Day weekend was over, her son took her to the hospital.
Langdon, a healthy, active woman of 51, had had a stroke. And like many people who suffer strokes, her life since that weekend in May 2002 hasn't been quite the same.
She doesn't run for exercise anymore; her weakened right arm keeps her off the tennis court.
And - most puzzling to her and others - when she speaks, her voice sounds like she comes from France.
The accent is rather odd for a woman who grew up in Missouri. And it's still much a mystery even to scientists who have studied cases similar to Langdon's.
Langdon is among only a couple of dozen known cases of people who developed what's been labeled Foreign Accent syndrome. In most cases, since the condition was first identified more than 80 years ago, their natural voices have been altered by some kind of brain trauma or head injury.
One researcher estimates fewer than 30 cases have been documented in scientific literature.
People who know Cindy Langdon, including colleagues and marketing clients, have by now taken her change of voice in stride.
When she meets new people, they often ask where she's from.
"It's annoying," she says, and sometimes she'll try to get away with replying that she's from somewhere in Italy or Brazil or France. Beats having to explain.
Before her stroke, most people knew Langdon as an effusive, creative woman. A divorced mother of three, she still operates a marketing, consulting and creative production firm out of her home.
In May 2002, Langdon says, she had two episodes that signaled something was wrong - flashes in one eye, ringing in her left ear, poor coordination and difficulty speaking were among the symptoms. After the stroke, Langdon emerged unable to speak and bound for months of physical and speech therapies.
"All she could do was smile," says daughter Morgan Langdon, now 24. "For someone who was active and very outspoken ... to go from that to nothing but facial expressions, that was traumatic. We couldn't fathom the idea that our mother could not speak."
Morgan returned from South Carolina, where she'd been a nursing student, to stay with her mother during her post-stroke recovery and rehab. Sons Dylan and Beau rallied round, as did Langdon's ex-husband, Tom, and numerous friends, all of whom visited her frequently and fretted over her future.
It took about six weeks or so before Langdon's voice began to come back. A friend, Janis Rovick, remembers being in the room when Langdon looked up and said "Hi."
But then Langdon had to learn how to speak all over again.
"I knew the words," she says now, "but I had to learn to form the words. There were some words I couldn't say and sounds I couldn't even make."
The speech therapist gave her facial exercises. She started with one-syllable words, then two and three syllables, then phrases and paragraphs.
As she watched her mother, Morgan Langdon realized it was like encountering a child who was learning to speak.
With two important differences.
For one, children are also learning word meanings as they learn to pronounce and Morgan's mother hadn't lost what she already knew.
The second difference was, her voice took on a different tone and shape, and no matter how much she tried to shake it, she was stuck with the new sound.
Nowadays her voice is slightly breathy, and sometimes there's a gap in rhythm or grammar that may evoke the sound of a non-native speaker of many languages.
Scientists who have studied patients with Foreign Accent syndrome have begun to understand the condition better in recent years as brain imaging technology has improved and as the Internet has made it easier to bring scattered research and researchers together, says Jack Ryalls of the University of Central Florida.
Ryalls has studied post-stroke speech problems for 25 years and saw his first case of Foreign Accent syndrome 20 years ago.
While brain researchers used to think language involved discrete regions of the brain - part of the frontal lobe, for instance, on the left hemisphere - now they theorize it involves a network of neurons crossing and connecting multiple regions.
Foreign accent syndrome may involve a lesion somewhere along that network, says Julius Fridriksson, assistant professor of communications sciences and disorders at the University of South Carolina.
Fridriksson, Ryalls and other colleagues published a scientific paper just last month involving a South Carolina man who began speaking with an accent after a stroke. The man, in his 40s, had no other disabilities and a year after his stroke completely regained his Southern accent.
Fridriksson's study concluded that the brain can often compensate for damage.
Doctors often note that a stroke patient's recovery will plateau within two years. Three and half years after her stroke, Langdon understands the implication of that. Perhaps her accent will never go away.
But, as neurologist Oliver Sacks wrote recently in a New Yorker article about aphasia, a more common and devastating communication disorder linked to strokes, the two-year timeline is not always firm. "I have seen this generalization," he noted, "proved false in many individual patients."
The act of speaking involves the movement and coordination of 50 muscles, Fridriksson says, and damage along the nerve network could affect any movement controlling the larynx or face or other speech-related body parts.
It's too soon to identify which of those brain fibers, neurons or muscle movements add up to a voice that sounds like an accented, non-native speaker of English or any other language. But the science, Ryalls says, is progressing "and cases like Cindy Langdon's are helping."
A better fit
One morning two years ago, Langdon had the television on and was startled to discover someone shared her problem, a woman who, after a stroke, spoke with a British accent. Langdon got in touch with producers of "Good Morning America," and soon Diane Sawyer had Langdon on the air in a brief follow-up interview.
The show aired Langdon's old answering-machine message, which callers to her business still hear. Her voice on it is sharp-edged and all-American, without the halting, lilting rhythms she speaks with now.
"It's almost like her new accent seems to fit her look and her personality," says Fred Paddock, an old friend and colleague. "When I work with her now, it does not sound strange any more. It just sounds like Cindy, or the new Cindy, I guess."
Her daughter and sons are grateful just to have her back in action and mostly recovered from the stroke.
They know it all could have been far more devastating.
And Morgan Langdon's not sure, but she thinks the accent has begun to recede a bit.
Today, Langdon still pauses at times, in search of words and phrases. She has filed a lawsuit over aspects of her diagnosis and treatment. And if people wonder whether her accent is real, well, she can't help that kind of uninformed opinion.
"I would talk in my own voice if I had it," she says. "I'd give anything to not talk in this voice."