The Foville syndrome is a midbrain syndrome, which manifests itself in the form of gaze palsy, Faszialislähmung and mutual hemiplegia. The cause are usually circulatory disorders or tumors in the brain area of the bridge foot. The treatment of the symptoms of paralysis depends on the primary cause.
What is Foville Syndrome?
According to ELECTRONICSMATTER, the brain stem (truncus cerebri or encephali) lies below the diencephalon, excluding the cerebellum. In addition to the midbrain (mesencephalon), the area of the brain stem encompasses the bridge (pons) and the elongated medulla (medulla oblongata). Like all other areas of the brain, the midbrain can also be affected by damage.
Such damage is associated with localization-dependent functional restrictions, which are classified in the group of midbrain syndromes. Foville syndrome is also a midbrain syndrome. The symptom complex was first described in 1859. The French neurologist and psychiatrist Achille-Louis-François Foville is considered to be the first to describe the syndrome and has bequeathed its name to the syndrome.
The designation as foville paralysis, foville bridge syndrome or caudal syndrome of the bridge hood is also considered to be widespread in the medical literature. Clinically, the associated damage to the bridge foot is typically manifested in a triad of symptoms consisting of gaze palsy, crossed hemiparesis and facial palsy.
Foville syndrome is a midbrain syndrome. Accordingly, the symptomatic complex is based on damage to the midbrain. Midbrain lesions in the area of the bridge foot are particularly associated with Foville syndrome. The cause of the damage can vary in nature.
In addition to tumors, circulatory disorders are the most important causes. At the base of the bridge there are two longitudinal bulges through which the pyramidal tract (Tractus pyramidalis) runs. In the middle groove, the basilar sulcus, runs an inflow for the oxygen and blood supply to the brain: the basilar artery.
If circulatory disorders are related to the Foville syndrome, it is usually circulatory disorders in the area of the basilar artery or its flow areas. In principle, other causes of the foville syndrome are also conceivable. Bacterial or autoimmune inflammations are one example.
Symptoms, ailments & signs
Like all syndromes, the Foville syndrome corresponds from a clinical point of view to a characteristic complex of individual symptoms. The clinical criteria of the syndrome include leitsymptomatisch especially paralysis as the ipsilateral peripheral Faszialisparese, the ipsilateral sixth nerve palsy and contralateral hemiparesis with hemianesthesia. Fascial paralysis manifests itself through a loss of function of the facial muscles.
This facial paralysis occurs on the same side as the causative brain lesion. The palsy of the abdomen paralyzes the lateral rectus muscle on the same side, which turns the eyeballs outwards. The medical professional understands hemiparesis to be hemiplegia.
In contrast to abducent and fascial palsy, hemiparesis occurs in the context of the foville syndrome on the opposite side of the brain damage and is related to an impairment of the pyramidal tracts close to the bridge foot. As a rule, hemiplegia is a spastic hemiparesis that pathologically increases the tone of the affected side.
The neurologist makes the first suspected diagnosis of Foville syndrome on the basis of clinical characteristics. In this context, the characteristic paralysis triad consisting of contralateral hemiparesis as well as ipsilateral gaze palsy and fascial palsy is relevant to the diagnosis. To confirm the diagnosis, the neurologist orders brain imaging.
Any damage in the area of the foot of the bridge can be seen in the slice images. After the diagnosis has been confirmed, a detailed diagnosis takes place. Tumor lesions, for example, show a relatively typical image in the MRI. The detailed diagnosis may also require a CSF analysis.
For this purpose, brain water is taken from the external liquor space and its composition is analyzed in the laboratory. The composition of the cerebral water changes in a relatively characteristic way during pathological processes in the brain area. In the CSF analysis, for example, tumor markers and inflammation markers can be identified. For patients with Foville syndrome, the prognosis depends on the primary cause.
Foville syndrome causes a number of complications in its course. Typical symptoms include symptoms of paralysis such as hemiparesis and fascial paralysis. The latter leads to a rapid loss of function of the affected muscles and, as a result, sometimes to severe movement disorders.
If a spastic hemiplegia occurs as a result of the mostly causal stroke, the limbs can only be moved to a limited extent or not at all. The facial paralysis can lead to a decrease in vision and a number of other complaints. Depending on the cause of Foville syndrome, severe brain damage can occur as the disease progresses. These can manifest themselves through behavioral problems and physical dysfunction, among other things.
Long-term therapy for the syndrome also carries risks. The prescribed immunosuppressants and antibiotics can lead to serious side effects. If radiation therapy is necessary, there is often further physical and mental deterioration, which manifests itself in weight loss, exhaustion and hair loss.
After a foville syndrome, those affected usually suffer from severe health impairments for their entire life, which can only be slowly reduced through physiotherapy and speech therapy.
When should you go to the doctor?
A doctor’s visit is necessary as soon as irregularities occur in the exercise of the usual body movements. Paralysis or abnormal sensations in the skin are considered unusual and should be clarified by a doctor. If numbness, extreme sensitivity to temperature influences or sensory disturbances occur, a doctor should be consulted. If the impairments increase in scope and intensity, a doctor’s visit is necessary as soon as possible. There is a risk of serious illnesses that must be prevented.
If the limbs can no longer be moved in the natural way or if the body is tilted, which is difficult to compensate with one’s own resources, a medical examination is necessary. There is cause for concern if there are noticeable changes in facial features or the inability to express normal facial expressions. If the eyelids can no longer be moved in the natural way or if the facial muscles are impaired, a doctor should be consulted.
If the person concerned perceives motor disorders, feels uncomfortable or suffers from a reduced level of performance, a medical check-up should be initiated. Malfunctions or failure symptoms of various systems must be examined and treated. Problems with vision or changes in vision must always be presented to a doctor. Consult a doctor in the event of unusual headaches, a vague feeling of illness or general weakness.
Treatment & Therapy
Therapy for patients with Foville syndrome depends on the cause. Basically, causal therapeutic approaches are to be preferred to symptomatic treatment options. While symptomatic approaches only alleviate individual symptoms, causal approaches address the primary cause of the overall complex.
An actual cure from the symptoms can only be achieved through causal treatment approaches. Symptomatic approaches are unsuitable for healing. If tumors are identified as the primary cause of the failure symptoms, excision is available as a causal treatment measure.
The tumors are removed as large as possible in an invasive operation. However, the sensitive nerve tissue structures of the brain must be taken into account in order not to cause permanent damage. If the tumor can only be operated on with high risks, a drug-based approach to damage limitation is an option.
Basically, the treatment decision in this case depends primarily on the degree of malignancy. If, instead of a tumor, circulatory disorders are responsible for the Foville syndrome, these disorders are mostly related to a primary cardiovascular disease. It is important to reduce risk factors for cardiovascular diseases.
For example, smoking should be given up. Obesity should be reduced and the diet can be changed if necessary. In this case, long-term treatment is usually conservative with medication. In the case of causal inflammation, the first thing to do is to heal the acute inflammation.
Depending on the type of inflammation, cortisone or antibiotic treatments may also be considered. In all cases of Foville syndrome, physiotherapeutic measures can help to regain full mobility.
Outlook & forecast
Depending on how quickly the underlying condition is treated, the Foville syndrome can develop very differently. With early treatment, any consequential damage to the musculoskeletal system can often be avoided.
In any case, the patient must undergo physiotherapy, as the Foville syndrome is always associated with certain symptoms of paralysis. In addition, brain damage can occur in the course of the disease, which represents a considerable burden for the person concerned. Physical dysfunctions and behavioral disorders are also conceivable and usually cause further complications that worsen the prognosis.
Despite all the measures taken, the sick usually suffer from permanent physical and mental impairments. Measures such as speech therapy, physiotherapy and drug treatment can only slowly alleviate the symptoms. In addition, due to the restricted physical condition as a result of the movement disorders, there is an increased risk of another stroke or the development of further tumors.
If left untreated, Foville syndrome can be fatal. Then paralysis, hemiparesis, visual disturbances and many other complaints develop, which significantly reduce the quality of life and also reduce life expectancy. An untreated tumor will eventually metastasize, resulting in the death of the patient. An untreated stroke can lead to immediate death.
Circulatory conditions in the form of the Foville syndrome can be prevented to a certain extent using general preventive measures in the context of cardiovascular diseases. Few preventive measures are available for causative inflammation and tumors in the area of the brain.
Despite various aftercare measures, those affected usually remain permanently physically and mentally impaired. Therapies such as speech therapy, physiotherapy, and drug treatment only provide gradual, slow relief from symptoms. However, possible impairment of the musculoskeletal system can often be avoided if Foville syndrome is treated early.
Physiotherapeutic treatment is, however, generally indicated in all cases, as symptoms of paralysis always occur as a result of Foville syndrome. Continued medical treatment is also essential. However, those affected and their relatives can also actively participate.
A healthy way of life such as avoiding alcohol and tobacco, changing your diet and reducing obesity, as well as physiotherapy and rehab sports generally have a positive effect on the course of the disease. Frequently occurring infections are comorbidities of the Foville syndrome. Here, too, patients and their relatives can actively cooperate and take preventive action.
Particularly in the home environment, particular attention should be paid to hygiene, such as frequent hand washing for everyone and the daily change of underwear and bed linen for patients. In order to cope with their everyday lives, patients of all ages need a lot of support. It is very cheap here when family and friends can be at your side.
A positive and supportive social environment almost always promotes the healing process and can help to alleviate mental upsets and depression. It often makes sense for those affected, relatives and friends to get support in a self-help group.
You can do that yourself
Foville syndrome usually cannot be cured with the help of self-help measures. In any case, a medical examination and treatment is necessary in order to make everyday life easier for the person concerned.
However, a healthy lifestyle and avoidance of obesity can have a positive effect on the course of the disease. Since those affected are often dependent on physiotherapy measures, the respective exercises can also be performed at home by the patient. Inflammation or infection is common due to Foville syndrome. For this reason, patients must also ensure excellent hygiene in order to prevent complications.
In most cases, the everyday life of the patient is made much easier with the help of other people. Above all, the help of friends and family has a very positive effect on everyday life and can avoid or alleviate possible psychological upsets or depression. Affectionate handling is necessary with children, as they can suffer particularly badly from paralysis. Discussions with a psychologist or a therapist can also be helpful.