Ashley Thornton, BS
Medical Student
Albany Medical College
Albany, New York, United States
Michael Downing, DO
Resident Physician
Albany Medical Center
Albany, New York, United States
Sarika Patel, MD
Attending Physician
Albany Medical Center
Albany, New York, United States
A 60 y.o. male presented to the hospital with symptoms of left facial droop, expressive aphasia, drooling, bowel incontinence, and altered mental status. He had a history of daily tobacco and alcohol use. Physical examination demonstrated oropharyngeal paralysis with severe dysphagia. Non-Contrast CT-Head displayed a wedge-shaped hypodensity in the left frontal operculum and insula, suspicious for subacute infarct. Subsequent MRI confirmed acute bilateral infarcts in the frontal operculum insular cortex. The patient’s hospital course was complicated by severe dysphagia, seizures, encephalopathy and insomnia.
Discussions:
Foix-Chavany-Marie Syndrome, or bilateral anterior opercular syndrome, is a rare condition typically resulting from bilateral opercular infarcts resulting in a supranuclear palsy. Characteristic clinical presentation includes facial, tongue, oropharyngeal, and vocal cord paralysis, thus severe impairment of a patient’s volitional ability to speak and swallow. This patient was admitted to the acute inpatient rehabilitation floor 8 days after admission. Upon admission to rehab, the patient was put on an International Dysphagia Diet Standardisation Initiative (IDDSI) 4 Pureed Diet and IDDSI 2 Mildly Thick liquids after a speech language pathologist’s assessment. An intense therapy regimen targeting oropharyngeal function was implemented. After acute rehabilitation, the patient was successfully discharged home on an IDDSI 6 Soft and bite sized diet and IDDSI 2 Mildly Thick liquids with recommendations for meal supervision and compensatory strategies.
Conclusions:
Clinical and MRI findings were consistent with Foix-Chavany-Marie Syndrome, a rare pseudobulbar paralysis often affecting volitional movements of anatomic structures innervated by Cranial Nerves V, VII, IX, X, and XII. Acute inpatient rehabilitation interventions resulted in a positive functional outcome.
