Abstract
We present four cases of the 'opercular syndrome' of volitional paresis of the facial, lingual, and laryngeal muscles (bilateral facio-glosso-pharyngo-masticatory paresis). Case histories and CT brain images are presented, along with a review of the literature concerning this long-recognized but little-known syndrome. The neuroanatomic basis of the syndrome classically involves bilateral lesions of the frontal operculum. We propose, on the basis of our cases and others, that the identical syndrome can arise from lesions of the corticobulbar tracts, not involving the cortical operculum. Our cases included one with bilateral subcortical lesions, one with a unilateral left opercular lesion and a possible, non-visualized right hemisphere lesion, one with unilateral cortical and unilateral subcortical pathology, and one with bilateral cortical lesions. These lesion localizations suggest that any combination of cortical or subcortical lesions of the operculum or its connections on both sides of the brain can produce a syndrome indistinguishable from the classical opercular syndrome. We propose the new term 'opercular-subopercular syndrome' to encompass cases with predominantly or partially subcortical lesions.
Highlights
The ‘opercular syndrome’, first described by Magnus in 1837, is known as Foix–Chavany–Marie syndrome, after French authors who reported the syndrome in 1926 [3, 7], and as facio-labio-pharyngoglosso-laryngo-brachial paralysis or the cortical type of pseudobulbar paralysis [18]
Most cases of the syndrome have had lesions of the anterior part of the operculum; some authors have referred to the syndrome as the ‘anterior opercular syndrome [15].’
Bilateral lesions of the posterior middle cerebral artery territory can cause pure word deafness without the ocular, facial, and laryngeal difficulties seen in the anterior opercular syndrome
Summary
On the basis of our cases and others, that the identical syndrome can arise from lesions of the corticobulbar tracts, not involving the cortical operculum. Our cases included one with bilateral subcortical lesions, one with a unilateral left opercular lesion and a possible, non-visualized right hemisphere lesion, one with unilateral cortical and unilateral subcortical pathology, and one with bilateral cortical lesions. These lesion localizations suggest that any combination of cortical or subcortical lesions of the operculum or its connections on both sides of the brain can produce a syndrome indistinguishable from the classical opercular syndrome. We propose the new term ‘opercularsubopercular syndrome’ to encompass cases with predominantly or partially subcortical lesions
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
