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Background Foix-Chavany-Marie syndrome (FCMS), otherwise known as bilateral anterior opercular syndrome, is a rare suprabulbar palsy. Vascular insults to the anterior opercular region are the typical cause of this syndrome.Clinical Case A 57 year-old-man presented to the Emergency Department with sudden onset facial palsy and drowsiness, with a National Institutes of Health Stroke Scale (NIHSS) score of 6. The only previous medical history included hypertension for which he was prescribed amlodipine 10 mg, candesartan 32 mg, and hydrochlorothiazide 25 mg. He received ‘code stroke’ management including a non-contrast computed tomography (CT) scan of his head, and a CT angiogram. CT scan shows a left basal ganglia intracranial haemorrhage with interventricular extension. He was admitted to the Intensive Care Unit (ICU), due to concerns for airway protection. A failed extubation resulted in emergency intubation in the ICU due to failure of opening at the temporo-mandibular joint (TMJ). A subsequent percutaneous tracheostomy was inserted. The patient had persistent dysfunction with mouth opening, no associated pain, and no involvement of the tongue. Magnetic resonance imaging (MRI) brain showed T1 hyperintensity along the tracts extending from the left anterior opercular region, with DWI restriction in the left anterior midbrain, likely reflecting vascular compression from the intracerebral haemorrhage. The patient had persistent difficulty with mouth opening, ongoing involuntary jaw clenching, and only slow improvement in swallowing.Conclusion This is a rare case of FCMS from a haemorrhagic stroke with unilateral involvement of tracts from the left anterior opercular region. Minimal improvement had been demonstrated.