Foix-Chavany-Marie syndrome, also known as bilateral anterior opercular syndrome is a partial paralysis of the face, pharynx and jaw caused by a loss of blood supply in a specific region of the brain. It was described in 1926 by Charles Foix, Jean Alfred Émile Chavany and Julien Marie in the Revue Neurologique.[1] As a characteristic, there is no paralysis of upper or lower limbs and those affected can still make involuntary movement like smiling, eating or blinking eyes.
A case of Foix-Chavany-Marie syndrome and crossed aphasia after right corona radiata infarction with history of left hemispheric infarction
Foix-Chavany-Marie syndrome (FCMS) is a syndrome that presents facio-pharyngo-glosso-masticatory diplegia with automatic voluntary dissociation. Its most common etiology is stroke in the regions of bilateral opercula. We described a 75-year-old woman with FCMS and crossed aphasia. She had cerebral infarction of left middle cerebral artery territory 23 years before. At that time she had transient right hemiparesis, but no aphasia. This time, she suddenly became mute and was brought to our hospital. Neurological examination revealed severe weakness in her bilateral lower face, pharynx, tongue, and sternocleidomastoideus. She had no weakness of limbs. Her listening comprehension was moderately disturbed and handwriting was paragraphic. Her emotional facial movement was maintained despite of disturbed volitional facial movement. CT scan disclosed fresh infarction at the right corona radiata and old infarction at the left middle cerebral artery territory. In this patient, lesions at the left operculum and right corona radiata with the preserved right operculum gave rise to FCMS. This implies following possibilities: 1) the corticobulbar tract and corticospinal tract run separately at the corona radiata, 2) volitional and emotional tracts of facial movement run separately at the corona radiata. It was demonstrated that FCMS is not always caused by bilateral operculum lesions. Our patient did not show aphasia after the first stroke including left language area, but became severely aphasic after the right corona radiata infarction. Simultaneous occurrence of FCMS and aphasia after corona radiata lesion suggested that the corticobulbar tract and a tract that conducts linguistic information are running adjacently in the corona radiata. Our case suggested that restricted corona radiata lesion may cause severe subcortical aphasia and in case of additional contralateral corticobulbar tract lesion, severe dysarthria may occur.
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A 79-year-old woman with a history of prior right frontal infarction presented with sudden inability to speak (figure, A). Examination revealed anarthria, yet intact comprehension, writing, and limb function (video). Voluntary tongue, swallowing, and mouth movements were absent, while cough and swallow reflexes were preserved (video). An acute left hemispheric ischemic stroke causing Foix-Chavany-Marie syndrome (FCMS) was diagnosed, and IV recombinant tissue plasminogen activator was administered. Left frontal infarction was confirmed on MRI
Figure (A) CT scan without contrast showing area of old right-sided infarct encompassing the frontoparietal opercular cortex; (B) diffusion-weighted MRI with restricted diffusion in the left precentral gyrus
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