When Karen Butler came out of sedation after oral surgery a year and a half ago, her mouth throbbed and her face was puffy. But that's not all that had changed. When she spoke, the words tumbled out in a thick and foreign accent. "I sounded like I was from Transylvania," she said. Over the next few days, the swelling subsided and the pain vanished, but Butler's newly acquired accent did not. Though it has softened over time, she's never again spoken like a native Oregonian from Madras. To most people, she sounds British. It took months to find an explanation: foreign accent syndrome, a disorder so rare that only about 60 cases have been documented worldwide since the early 1900s. She's the first known case in Oregon, said Ted Lowenkopf, MD, medical director of the statewide Providence Stroke Center.