Teaching Video NeuroImages: Foix-Chavany-Marie syndrome

Summary

  • 75yo F
  • c/c
    • uni ischemic stroke
    • sudden loss f volitional ctrl of musc
    • crucial for speakig & swallowing
  • HPI
    • multi resolved hemiparetic stroke
  • PEx
    • automatic movements preserved
  • Dx
    • Foix-Chavany-Marie syndrome

Further

Terminology

Original

A 75-year-old woman with a history of multiple resolved hemiparetic strokes presented with unilateral ischemic stroke causing sudden loss of volitional control of the musculature crucial for speaking and swallowing. Automatic movements, such as laughter and yawning, were preserved (video 1 and figure). She was diagnosed with Foix-Chavany-Marie syndrome (FCMS). Lesions of the operculum or its projections to brainstem nuclei can cause FCMS.1 Because these muscles receive bilateral innervation, a new unilateral lesion can produce sudden bilateral weakness if an old contralateral lesion was compensated by the intact hemisphere. Spontaneous movements, controlled by extrapyramidal pathways, are preserved.2

Video 1

Video

This video shows the clinical examination of the patient demonstrating Foix-Chavany-Marie syndrome.

Figure

Figure

Neuroimaging of Foix-Marie-Chavany syndrome
(A) T2 fluid-attenuated inversion recovery (FLAIR) MRI demonstrates substantial preexisting ischemic burden, notably in the left pons.
(B) Our patient compensated for these previous insults, until a small unilateral stroke of the right corona radiata caused bilateral weakness of the muscles crucial for speaking and swallowing.

References

  1. Weller M. Anterior opercular cortex lesions cause dissociated lower cranial nerve palsies and anarthria but no aphasia: Foix-Chavany-Marie syndrome and “automatic voluntary dissociation” revisited. J Neurol 1993;240:199–208.
  2. Hopf HC, Muller-Forell W, Hopf NJ. Localization of emotional and volitional facial paresis. Neurology 1992;42:1918.