Atypical Presentations of Foix-Chavany-Marie Syndrome (FCMS) in Stroke

Area of Science:

• Neurology
• Neuroscience
• Clinical Medicine

Background:

• Foix-Chavany-Marie syndrome (FCMS), also known as bilateral (B/L) anterior operculum syndrome, is defined by anarthria and central paralysis of facial, lingual, palatal, and masticatory muscles.
• Cerebrovascular disease is the most frequent etiology, but FCMS can also result from CNS infections, developmental disorders, epilepsy, and neurodegenerative conditions.

Observation:

• This report details two atypical FCMS cases in adult males with hypertension, diabetes, and smoking history.
• Both patients presented with acute onset of FCMS symptoms following prior hemiplegia.
• Brain imaging revealed infarcts in the perisylvian region and internal capsule, but notably lacked the classical bilateral opercular lesions.

Findings:

• The presented cases demonstrate that FCMS can manifest without the expected bilateral opercular lesions.
• One patient even presented without any unilateral opercular lesion, challenging established diagnostic criteria.
• The clinical diagnosis of FCMS was confirmed by bifacial, lingual, and pharyngolaryngeal palsy in both individuals.

Implications:

• These findings suggest that the anatomical basis for FCMS is broader than previously understood, extending beyond the opercular regions.
• Clinicians should consider FCMS in the differential diagnosis of anarthria and central orofacial paralysis, even in the absence of typical imaging findings.
• Further research is warranted to fully elucidate the neuroanatomical substrates and etiological spectrum of FCMS.