Letter to the editor
Bilateral corona radiata
infarcts: a new
topographic location of
Foix–Chavany–Marie
syndrome
Dear editor,
Foix–Chavany–Marie syndrome (FCMS)
is a rare cortical type of pseudobulbar
palsy characterized by automatic–
voluntary dissociation of motor function
of cranial nerves V, VII, IX, X and XII (1).
We encountered a case of FCMS with
an atypical infarct site of the bilateral
corona radiatae, causing a diagnostic
delay.
This 77-year-old man presented with
acute onset of inability to speak or
swallow upon waking in the night. His
past medical history included a left corona
radiata infarct with no residual disability,
Waldenstrom’s macroglobulinemia and

Correspondence: Nicola Bradley*,
Department of Stroke Medicine,
Addenbrooke’s Hospital, Cambridge
CB2 0QQ, UK.
E-mail: nicola.bradley1@nhs.net
Conflicts of interest: None declared.
DOI: 10.1111/ijs.12387

anemia. On examination, he was anarthric without expressive or receptive dysphasia or dysgraphia. His mouth was half
open with an inability to voluntarily move
it further, though he could yawn. He was
unable to protrude his tongue. He
had an expressionless face with pseudoperipheral bilateral facial palsy and severe
dysphagia. The rest of the neurological
examination was normal. A CT head
identified established left corona radiata
lacunar infarct. MRI imaging demonstrated an acute infarct in the right corona
radiata (Fig. 1), confirming the diagnosis
of FCMS. Despite intensive speech and
language therapy, he made minimal
improvement, has a percutaneous endoscopic gastrostomy tube for feeding and
remains severely dysarthric.
To our knowledge, FCMS secondary
to bilateral corona radiata infarcts has
not been reported. The hallmarks of
FCMS are anarthria and loss of voluntary
control of the facio-pharyngeo-glossomasticatory muscles, with preserved automatic and involuntary emotional reflexes
(1). Initial diagnosis can be challenging.
Reported cases of acute FCMS in the literature include bilateral, or rarely unilateral, opercular infarcts (2,3); or infarcts in
the left operculum and right corona

radiata (4).We highlight that FCMS can
also be caused by bilateral infarcts in the
corona radiata. Greater awareness of this
rare syndrome among stroke specialists is
essential to avoid delay in diagnosis and
neurorehabilitation.
Nicola Bradley*, Niamh Hannon,
Caroline Lebus, Eoin O’Brien, and
Kayvan Khadjooi
Department of Stroke, Addenbrooke’s
Hospital, Cambridge, UK

References
1 Mariani C, Spinnler H, Sterzi R et al. Bilateral perisylvian softenings: bilateral anterior
opercular syndrome (Foix-Chavany-Marie
Syndrome). J Neurol 1980; 223:269–84.
2 Ohtomo R, Iwata A, Tsuji S. Unilateral
opercular infarction presenting with
Foix-Chavany-Marie Syndrome. J Stroke
Cerebrovasc Dis 2014; 23:179–81.
3 Foix C, Chavany JA, Marie J. Diplégiefaciolinguo-masticatriced’origine sous-corticale
sans paralysie des membres (contribution à
l’étude de la localisation des centres de la face
du membresupérieur). Rev Neurol (Paris)
1926; 33:214–9.
4 Kobayashi S, Kunimoto M, Takeda K. A case
of Foix-Chavany-Marie syndrome and
crossed aphasia after right corona radiata
infarction with history of left hemisphere
infarction. Rinsho Shinkeigaku 1998;
38:910–4.

Fig. 1 MRI scan of a 77-year-old male presenting with Foix–Chavany–Marie syndrome, demonstrating an acute infarct in the right corona radiata and an
established infarct in the left corona radiata (Left: T2, Right: Diffusion-weighted imaging).

© 2014 World Stroke Organization

Vol 9, December 2014, E39

E39