JPMA. The Journal of the Pakistan Medical Association · 1986
Congenital diaphragmatic hernia in the adult.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Gardezi S A, Chaudhry A M, Sial G A, Ahmad I, Rashid M, Yusuf A, Siddique S, Gardezi J R, Shafique T
Аннотация
INTRODUCTION: Foix-Chavany-Marie syndrome (FCMS) or bilateral opercular syndrome (OPS) is a rare pseudobulbar palsy characterized by facial, lingual, pharyngeal, and masticatory voluntary muscle paralysis resulting in anarthria with preservation of autonomic, involuntary, and reflexive functions. Damage to the posterior part of the inferior frontal gyrus and inferior part of precentral gyrus play a role in the pathogenesis of FCMS.
CASE DESCRIPTION: We report a rare case of bilateral OPS following an acute right middle cerebral artery (MCA) infarct in a patient with history of glioblastoma, and resection in the left MCA territory within the cingulate gyrus, showing recovery of speech and swallowing despite intensive bilateral opercular lesions owing to extensive multidisciplinary team support. However, the patient was discharged with a percutaneous endoscopic gastrostomy tube for long-term enteral feeding support due to partial recovery.
DISCUSSION: The patient's history of glioblastoma, left MCA cingulate gyrus resection and right MCA infarction with automatic-voluntary dissociation led to the diagnosis of FCMS. Rehabilitation surprisingly showed mild improvement in speech and swallowing despite extensive bilateral opercular lesions proving that there are still chances of improvement in speech and swallowing in OPS with the right multidisciplinary approach.
CONCLUSION: Patients with a history of brain tumours like glioblastoma can develop bilateral OPS later in life in case of other vascular events that cause lesions in a previously unaffected operculum, triggering symptoms. Extensive involvement of the speech and language team is of significant in the management of FCMS cases as above where some recovery might still be seen.
LEARNING POINTS: Foix-Chavany-Marie syndrome (FCMS) can be caused by bilateral opercular lesions (new or old or a combination of both) in patients with history of high-grade brain tumours.Patients with bilateral opercular syndrome experience full or partial or no recovery at all of speech and swallowing, hence proper rehabilitation with a Speech and Language Team is significant.Understanding automatic-voluntary dissociation in FCMS and being able to differentiate it from bulbar palsy and other similar phenomena is crucial in making a diagnosis of FCMS.
CASE DESCRIPTION: We report a rare case of bilateral OPS following an acute right middle cerebral artery (MCA) infarct in a patient with history of glioblastoma, and resection in the left MCA territory within the cingulate gyrus, showing recovery of speech and swallowing despite intensive bilateral opercular lesions owing to extensive multidisciplinary team support. However, the patient was discharged with a percutaneous endoscopic gastrostomy tube for long-term enteral feeding support due to partial recovery.
DISCUSSION: The patient's history of glioblastoma, left MCA cingulate gyrus resection and right MCA infarction with automatic-voluntary dissociation led to the diagnosis of FCMS. Rehabilitation surprisingly showed mild improvement in speech and swallowing despite extensive bilateral opercular lesions proving that there are still chances of improvement in speech and swallowing in OPS with the right multidisciplinary approach.
CONCLUSION: Patients with a history of brain tumours like glioblastoma can develop bilateral OPS later in life in case of other vascular events that cause lesions in a previously unaffected operculum, triggering symptoms. Extensive involvement of the speech and language team is of significant in the management of FCMS cases as above where some recovery might still be seen.
LEARNING POINTS: Foix-Chavany-Marie syndrome (FCMS) can be caused by bilateral opercular lesions (new or old or a combination of both) in patients with history of high-grade brain tumours.Patients with bilateral opercular syndrome experience full or partial or no recovery at all of speech and swallowing, hence proper rehabilitation with a Speech and Language Team is significant.Understanding automatic-voluntary dissociation in FCMS and being able to differentiate it from bulbar palsy and other similar phenomena is crucial in making a diagnosis of FCMS.