Case Report
Bilateral anterior opercular (Foix–Chavany–Marie) syndrome

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Abstract

The bilateral anterior opercular (Foix–Chavany–Marie) syndrome is a rare condition most commonly encountered after bilateral middle cerebral artery stroke. Clinically, the syndrome is characterised by a loss of voluntary control of the facio-pharyngeo-glosso-masticatory muscles, while reflex movements and limb strength are preserved. We report the clinical presentation of a patient with anterior biopercular syndrome due to a bilateral middle cerebral artery stroke.

Introduction

The bilateral anterior opercular (Foix–Chavany–Marie) syndrome was first described in 1926.1 The syndrome is caused by bilateral lesions of the anterior frontoparietal opercula, most frequently due to ischaemic stroke.2 Voluntary movements of the cranial muscles innervated by the trigeminal, facial, glossopharyngeal, vagus and hypoglossus nerves are bilaterally lost.[1], [2] The affected individuals suffer from bilateral facial weakness and an inability to speak and chew, while the swallowing function is generally only mildly affected. There is dissociation between voluntary and automatic muscle activity: reflexes and automatic or emotional movements in those muscles that are voluntarily paralysed are well preserved,[2], [3], [4] which means that the corneal reflex, the threaten reflex, and emotional laughing or crying are all possible.[1], [4]

Section snippets

Case report

A 79-year-old female with medically treated arterial hypertension and diabetes mellitus presented to our facility with bilateral facial weakness and a sudden inability to speak. She had completely recovered from an ischaemic stroke in the right middle cerebral artery territory, which had occurred 6 years previously. Examination revealed anarthria, but well-preserved comprehension, writing and limb function. When requested, she was unable to speak or perform voluntary facial or tongue movements.

Discussion

The Foix–Chavany–Marie syndrome is caused by bilateral lesions of the anterior frontotemporal opercula1 or the cortico-subcortical areas of the primary motor cortex.2 Voluntary control of facio-pharyngo-glosso-masticatory muscles is lost, although emotional and reflex movements in these muscles, as well as limb strength, is preserved.[1], [2], [3], [4] When confronted with acute anarthria and an inability to perform voluntary facial and tongue movements, all in the absence of limb weakness and

References (4)

  • C. Foix et al.

    Diplégie facio-linguo-masticatrice d’origine sous-corticale sans paralysie des membres (contribution à l’étude de la localisation des centres de la face du membre supérieur)

    Rev Neurol

    (1926)
  • J. Weller

    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)
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