RESIDENT & FELLOW SECTION Teaching Video NeuroImages: Foix-ChavanyMarie syndrome William G. Mantyh, MD,* Adithya Chandregowda, PhD,* Jimmy R. Fulgham, MD, Kelly D. Flemming, MD, Ruple S. Laughlin, MD, and David T. Jones, MD ® Neurology 2019;92:e2620-e2621. doi:10.1212/WNL.0000000000007569 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 Correspondence Dr. Jones jones.david@mayo.edu MORE ONLINE Teaching slides links.lww.com/WNL/ A901 Figure Neuroimaging of Foix-Marie-Chavany syndrome Video (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. *These authors contributed equally to this work. From the Departments of Neurology (W.G.M., A.C., J.R.F., K.D.F., R.S.L., D.T.J.) and Radiology (D.T.J.), Mayo Clinic, Rochester, MN. Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. e2620 Copyright © 2019 American Academy of Neurology Copyright © 2019 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. preserved (video 1 and figure). She was diagnosed with FoixChavany-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 Appendix (continued) Name Location Role Contribution Jimmy R. Fulgham, MD Mayo Clinic Rochester, MN Author Interpreted the data, revised the manuscript for intellectual content Kelly D. Flemming, MD Mayo Clinic Rochester, MN Author Interpreted the data, revised the manuscript for intellectual content Ruple S. Laughlin, MD Mayo Clinic Rochester, MN Author Interpreted the data, revised the manuscript for intellectual content David T. Jones, MD Mayo Clinic Rochester, MN Author Analyzed the data, drafted the manuscript for intellectual content Study funding No targeted funding reported. Disclosure The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures. Appendix Authors Name Location Role Contribution William G. Mantyh, MD Mayo Clinic Rochester, MN Author Designed and conceptualized study, analyzed the data, drafted the manuscript for intellectual content Adithya Chandregowda, PhD Mayo Clinic Rochester, MN Author Neurology.org/N References 1. 2. 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. Hopf HC, Muller-Forell W, Hopf NJ. Localization of emotional and volitional facial paresis. Neurology 1992;42:1918. Designed and conceptualized study, analyzed the data, drafted the manuscript for intellectual content Neurology | Volume 92, Number 22 | May 28, 2019 Copyright © 2019 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. e2621