Affiliations: Department of Neurology, Uludag University, Bursa,
Turkey | Department of Neurology, Vanderbilt University School
of Medicine, Nashville, TN 37232, USA.
Note: [] Corresponding author: Howard S. Kirshner, Professor and Vice
Chair, Department of Neurology, Vanderbilt Medical Centre South #362, 2100
Pierce Avenue, Nashville, TN 37212, USA.
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.
