Foville's Syndrome a Case to Remember: Case Report

Abstract

The Foville’s Syndrome is a rare clinical feature of stroke or brain hemorrhage. This is very rare
brain stem syndrome and only few cases have been reported worldwide. A case of Foville's syndrome
secondary to infarction at the left paramedian pontine region, which was diagnosed and treated at
Annapurna Neurological institute and allied Science, Kathmandu, Nepal. A 62 years old gentleman
presented with acute headache with sudden onset of vertigo, tinnitus, slurred speech, diffi culty while
swallowing and numbness and hemiparesis on the right side of the body. The aim of this study was
to report a rare case of Foville's syndrome with the infarction at the left paramedian pontine region.
The clinical manifestations were well correlated with anatomical involvement. The CT-scan of head,
Magnetic Resonance Imaging (MRI), MR-Angiogram (MRA) sequence of cerebral and carotid, etc.
helped in the diagnosis of the case along with the other lab investigations.

Full text

How to cite this article: Acharya S, Chandra A, Chandra A, Pant B. Foville’s Syndrome a Case to Remember: Case Report. J Biomed Res
Environ Sci. 2021 Oct 30; 2(10): 1015-1017. doi: 10.37871/jbres1344, Article ID: JBRES1344, Available at: https://www.jelsciences.com/
articles/jbres1344.pdf
CASE REPORT
Foville’s Syndrome a Case to
Remember: Case Report
Sudikshya Acharya1, Ayush Chandra2,3, Avinash Chandra4* and Basant
Pant1
1Annapurna Neurological Institute and Allied Sciences, Maitighar, Kathmandu, Nepal
2Tianjin Medical University, Tianjin, P.R. China
3Multiple Sclerosis Society Nepal, Kathmandu, Nepal
4National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
*Corresponding author
Avinash Chandra, Neurology Department,
National Academy of Medical Sciences, Bir
Hospital, Kathmandu, Nepal
Tel: +977-980-120-3237
E-mail: chandraavi@gmail.com
DOI: 10.37871/jbres1344
Submitted: 16 October 2021
Accepted: 27 October 2021
Published: 30 October 2021
Copyright: © 2021 Acharya S, et al. Distributed
under Creative Commons CC-BY 4.0
OPEN ACCESS
Keywords
Foville syndrome
Infarction
Pontine region
Neurology
Stroke
VOLUME: 2 ISSUE: 10 - OCTOBER
MEDICINE GROUP
NEUROLOGY BRAIN DISORDERS
DEPRESSION MENTAL HEALTH PSYCHIATRY
NEUROLOGICAL DISORDERS NEUROSURGERY
The Foville’s Syndrome is a rare clinical feature of stroke or brain hemorrhage. This is very rare
brain stem syndrome and only few cases have been reported worldwide. A case of Foville's syndrome
secondary to infarction at the left paramedian pontine region, which was diagnosed and treated at
Annapurna Neurological institute and allied Science, Kathmandu, Nepal. A 62 years old gentleman
presented with acute headache with sudden onset of vertigo, tinnitus, slurred speech, diffi culty while
swallowing and numbness and hemiparesis on the right side of the body. The aim of this study was
to report a rare case of Foville's syndrome with the infarction at the left paramedian pontine region.
The clinical manifestations were well correlated with anatomical involvement. The CT-scan of head,
Magnetic Resonance Imaging (MRI), MR-Angiogram (MRA) sequence of cerebral and carotid, etc.
helped in the diagnosis of the case along with the other lab investigations.
ABSTRACT
INTRODUCTION
The Foville’s Syndrome is a rare clinical feature of stroke or brain hemorrhage.
It is characterized by sixth nerve palsy, facial palsy, facial hypoesthesia, peripheral
deafness, Horner’s syndrome, contralateral hemiparesis, ataxia, pain, and thermal
hypoesthesia, with lesions in the pontine tegmentum [1]. Very few cases have
been reported worldwide. Foville’s syndrome was fi rst described by the French
anatomist and psychiatrist Achille-Louis François Foville in 1858 [2]. The aim of
our study is to report a rare case of Foville's syndrome secondary to infarction at
the left paramedian pontine region, which was diagnosed and treated at Annapurna
Neurological institute and allied Science, Kathmandu, Nepal.
CASE PRESENTATION
A 62-year-old male presented to the emergency department with a complaint
of acute headache with sudden onset of vertigo, tinnitus, slurred speech, di culty
while swallowing and numbness and hemiparesis on the right side of the body. He
denied any history of systemic disease, trauma or alcohol consumption. The patient
also had complaint of pain in right eye without having any other visual complaints.
The results of ophthalmological examination were found normal. On neurological
examination with muscle power assessment (MRC Scale) revealed that motor power
being 4/5 on limbs on the right side. Hemiparesis also involved right side of face
with loss of vibratory sense. On further examination of cranial nerve, which showed
patient’s gag refl ex was absent on right side. In order to support the diagnosis of this
case, several radiological investigations were performed such as CT-scan of head
which showed acute infarction at left paramedian pontine region. The Magnetic

Acharya S, et al. (2021) J Biomed Res Environ Sci, DOI: https://dx.doi.org/10.37871/jbres1344 1016
Resonance Imaging (MRI) DWI/ADC mapping showed small
focal di usion restriction noted in left paramedian pontine
(Figure 1A & 1B).
Further, MR-Angiogram (MRA) sequence of cerebral
and carotid was done, which showed, slightly reduced
caliber of the right Internal Carotid Artery (ICA) throughout
its course with 60% of focal stenosis at right petro-
cavernous junction as well as stenosed vertebral artery
(right more than left) (Figure 2). According to the clinical
manifestations and neuroimaging fi ndings, Foville’s
syndrome with contralateral hemiparesis resulting from the
left paramedian pontine region infarction was diagnosed.
The patient was admitted and received supportive
treatment. Also, rehabilitation techniques were used to
address residual functional defi cit through physiotherapy
and acupuncture. Serial laboratory investigations including
Complete Blood Count (CBC), electrolyte, prothrombin time,
activated partial thrombin time, protein C, protein S, urine
catecholamine, antinuclear antibody, antiphospholipid
antibody, cardiolipin antibody and thyroid function were
conducted and their results came in as normal range except
for mildly elevated Erythrocyte Sedimentation Rate (ESR)
i.e. 65 mm/hr.
DISCUSSION
The foville’s syndrome or defoville’s syndrome was
fi rst described by the French anatomist and psychiatrist
Achille-Louis Francois Foville in 1858 [2,3]. The characters
of this syndrome is sixth nerve palsy, facial palsy, facial
hypoesthesia, peripheral deafness, Horner’s syndrome
and contralalteral hemiparesis, ataxia, pain and thermal
hypoesthesia. The syndrome suggested a lesion in lower
pontine tegmentum, which has been reported in association
with pontine infarction, hemorrhage, tuberculoma and
cerebellar tumors [4,5]. In another variation of this
syndrome, superior pons type of foville’s syndrome had also
been proposed and been reported in association with the
upper pontine region [6], this occurs in association with the
upper pons and is caused by aneurysm of basilar artery [7].
In this patient, he had complained of pain on the right
eye and had limited abduction and adduction, suggestive
of involvement of the right abducens fascicle and medial
longitudinal fasciculus, which were di erent from the
classical foville’s syndrome. The patient also presented
with the right facial palsy, right facial aesthesia, right
hemiparesis and right hemiparaesthesia which represent
the involvement of the facial nerve fascicle, trigeminal tract,
uncrossed corticosipinal tract and uncrossed spinothalamic
tract. Ipsilateral was noted while in emergency department
and later in Hospital Outpatient Department (HOD) during
the follow-up. Hence, the patient was suggested to be
monitored for the possible HOD-associated movement
disorders in the future, if need then should be rushed to the
HOD.
CONCLUSION
We would like to conclude, as we reported a rare case of
Foville’s syndrome with contralateral hemiparesis due to
infarction in left paramedian pontine region. The clinical
manifestations were well correlated with anatomical
involvement.
ACKNOWLEDGEMENT
The authors like to acknowledge the patient and her
guardian for providing the required information and consent
for this case report.
Authors contribution
All the authors have equally contributed from the time of
handling this case to the manuscript formation.
Ethics approval and consent to participate
Ethical approval was taken from Institutional Review
Board (IRB) of Annapurna Neurological Institute and
Allied Sciences (ANIAS), Kathmandu Nepal. Consent to
participation was collected from the patient.
Consent for publication
Patient has provided Consent for publication of data.
A) B)
Figure 1 MRI, DWI/ADC mapping.
Figure 2 It explains Internal Carotid Artery.

Acharya S, et al. (2021) J Biomed Res Environ Sci, DOI: https://dx.doi.org/10.37871/jbres1344 1017
How to cite this article: Acharya S, Chandra A, Chandra A, Pant B. Foville’s Syndrome a Case to Remember: Case Report. J Biomed Res Environ Sci. 2021 Oct 30; 2(10): 1015-1017. doi: 10.37871/
jbres1344, Article ID: JBRES1344, Available at: https://www.jelsciences.com/articles/jbres1344.pdf
Availability of data and material
All the data are available with the corresponding author
and can be made available as per required.
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