Disclosures: Xiao Qiu, MD, MSc: Nothing to disclose

Case Description: A 50-year-old female presented with difficulties in speaking, swallowing, moving the tongue, and chewing after embolization of an aneurysm in the right middle cerebral artery 2 months ago. Brain magnetic resonance imaging (MRI) showed acute infarction in the right opercular region and a remote lesion in the left basal ganglia. On physical exam, she was unable to voluntarily open or close her mouth, show her teeth, prepare or chew the food. She was drooling constantly. Interestingly, she was able to swallow safely once food was placed at the posterior oral cavity. She was able to close her eyes during sleep, yawn spontaneously, laugh and cry under appropriate conditions. She was only able to pronounce “uh”. Therapies included oral muscle exercises, sensory stimulation, breath holding and phonation technique, low-frequency electrical stimulation, 20 minutes of 1Hz repetitive transcranial magnetic stimulation (TMS) daily for 10 days, 30 minutes of acupuncture daily for 15 days at selected points. Assessments were performed before and after treatments.

Setting: Acute inpatient rehabilitation unit in a tertiary hospital

Patient: A 50-year-old female with history of hypertension and prior right-sided facial palsy.

Assessment/Results: After 3 weeks of treatments, the patient had improvements in opening her mouth voluntarily up to 6 cm, chewing soft foods, protruding her tongue and pronouncing “a”, “i” and “u”. She remained unable to speak words or sentences. The modified Frenchay Dysarthria Assessment (Chinese version) improved by 22 points.

Discussion: FCMS is a rare type of pseudobulbar palsy characterized by loss of voluntary control of the facial, glossal, pharyngeal, laryngeal, and masticatory muscles with preserved automatic, involuntary movements, also called "automatic-voluntary dissociation". Patients with bilateral, large, cortical lesions may be related to poor recovery. Those with unilateral, smaller, subcortical lesions may have a relatively good recovery.

Conclusion: Intensive multimodal rehabilitation therapy may be helpful in the functional recovery of FCMS.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/multimodal-rehabilitation-for-foix-chavany-marie-syndrome-fcms-a-case-report/