Effect of bilateral opercular syndrome on speech perception

Speech perception ability and structural neuroimaging were investigated in two cases of bilateral opercular syndrome. Due to bilateral ablation of the motor control center for the lower face and surrounds, these rare cases provide an opportunity to evaluate the necessity of cortical motor representations for speech perception, a cornerstone of some neurocomputational theories of language processing. Speech perception, including audiovisual integration (i.e., the McGurk effect), was mostly unaffected in these cases, although verbal short-term memory impairment hindered performance on several tasks that are traditionally used to evaluate speech perception. The results suggest that the role of the cortical motor system in speech perception is context dependent and supplementary, not inherent or necessary.

Importance of Rapid Clinical Recognition of the Anterior Opercular Syndrome (Foix-Chavany-Marie Syndrome): A Case Report

We have described a 55-year-old woman with the anterior opercular syndrome (Foix-Chavany-Marie syndrome). The clinical presentation included acute onset of bilateral facial palsy and anarthria. Immediate MRI of the brain revealed acute ischemia in the right opercular region and sequelae after a previous infarction involving the left opercular region. The patient was treated with intravenous thrombolysis resulting in full recovery. The anterior opercular syndrome is rare, and the most common reason is sequential stroke. We emphasize the importance of recognizing this syndrome early, and in all cases, consulting a revascularization center immediately.

Unilateral opercular lesion mimicking opercular syndrome

Introduction: Foix-Chavany-Marie syndrome, also known as opercular syndrome, consists of voluntary orofacial muscle paralysis due to bilateral lesions in the anterior frontotemporal operculum. Classically, there is an automatic-voluntary dissociation, with impairment of speech and chewing. We present a case of a patient who had a similar presentation to opercular syndrome, secondary to unilateral ischemic lesion in the right frontal operculum. Case report: A 55-year-old, right-handed, black woman with history of arterial hypertension was admitted to the emergency department presenting left-sided weakness and inability to speak, noticed upon waking. When approached, the patient was unable to produce sounds but managed to communicate through articulatory movements of lips and was able to write correctly without signs of aphasia. On examination, there was left central facial paralysis, marked reduction in mouth opening amplitude, inability to perform tongue protrusion without lateral deviation and bilateral reduction in palate elevation. There was also a mild left brachial- predominant hemiparesis (grade IV). A cranial computed tomography scan exhibited an acute ischemic lesion of the right frontal opercular region, without other lesions in the homologous contralateral area. The etiological investigation with electrocardiogram, echocardiogram and carotid doppler ultrasound had no significant abnormalities. Conclusion: We reported a case of a patient presenting with aphonia and bulbar musculature paresis due to a right unilateral frontal opercular lesion, mimicking the opercular syndrome presentation.

A Rare Case of Unilateral Foix-Chavany-Marie Syndrome

Background: Bilateral anterior opercular syndrome, or Foix-Chavany-Marie Syndrome (FCMS), is a neurological condition characterized by bilateral anterior opercular lesions. Common presenting symptoms of this rare suprabublar palsy include dysarthria, or slurred speech, as well as paralysis of facial, pharyngeal, lingual, and masticatory voluntary muscles while autonomic function is preserved.1 Most cases of FCMS are bilateral, yet some rare cases have been reported with unilateral opercular lesions with preexisting contralateral white matter lesions.2 In this case report we present a rare case of unilateral FCMS in a patient who had an acute anterior left opercular infarct, as well as a residual right parietal subcortical stroke. Project Methods: The patient we present is a 49 year old African American female with a history of hypertension and previous stroke with residual spastic right hemiplegia who presented to the ED for evaluation of right sided facial droop, right sided weakness, and slurred speech. Patient was evaluated by acute stroke team and was treated with intravenous thrombolysis (Alteplase). On hospital day 2, the patient developed complete disarticulation, unable to produce any speech but able to communicate by appropriate gestures and writing. The patient’s symptoms included anarthria, weakness of bilateral masseters, and lateral/medial pterygoids without dysphagia. Results: The MRI brain showed left insular region/frontal opercular ischemic stroke and a small right parietal subcortical ischemic stroke, likely embolic in nature. Over the hospital stay, the patient’s motor function improved but her anarthria persisted. These radiologic findings along with the symptomology proved consistent with FCMS. She was discharged to home with an NIH stroke scale of 5 and recommended outpatient speech therapy. Conclusion: In this case report, we describe a patient that presents with an extremely rare case of unilateral FCMS, with a preexisting contralateral parietal infarct that could have collectively caused anarthria and masseter weakness. Works Cited 1. Milanlioglu A, Aydın MN, Gökgül A, Hamamcı M, Erkuzu MA, Tombul T. Ischemic Bilateral Opercular Syndrome. Case Reports in Medicine. 2013;2013:1-3. doi:10.1155/2013/513572. 2. Sa F, Cordeiro IM, Mestre S, Nzwalo H. Unilateral opercular infarction presenting with FoixChavany-Marie syndrome. Case Reports. 2014;2014. doi:10.1136/bcr-2014-206439.