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Acute Bilateral Opercular Strokes Causing Loss of Emotional Facial Movements

Published online by Cambridge University Press:  02 December 2014

Valerie L. Sim ,
Alan Guberman  and
Matthew J. Hogan
Valerie L. Sim
Affiliation:
Department of Neurology, The Ottawa Hospital, Ottawa, ON Canada
Alan Guberman
Affiliation:
Department of Neurology, The Ottawa Hospital, Ottawa, ON Canada
Matthew J. Hogan
Affiliation:
Department of Neurology, The Ottawa Hospital, Ottawa, ON Canada
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Abstract

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The classic anterior opercular syndrome of Foix-Chavany-Marie presents with loss of voluntary facial, pharyngeal, lingual, and mastication movements, with preservation of emotional and automatic movements. Most commonly, sequential strokes affecting bilateral opercula cause this syndrome. The inverse clinical presentation, with selective loss of emotional facial movements, has only rarely been reported, and is less well-localized.

Case report:

We report a case of selective loss of emotional facial movements which resulted from bilateral acute infarcts. No etiology was discovered, and the syndrome was reversible.

Discussion:

The available literature, and findings in this case, suggest that voluntary and automatic facial movements have distinct pathways, and damage to the insula bilaterally may lead to the selective loss of emotional facial movements. The clinical presentation of this inverse automatic/voluntary dissocation needs to be recognized as a rare syndrome with bilateral localization, so that patients at higher risk of further stroke can quickly be identified.

Résumé:

RÉSUMÉ:

Dans le syndrome operculaire antérieur classique (SOA) de Foix–Chavany–Marie, on observe une perte des mouvements volontaires de la face, du pharynx, de la langue et de la mastication et une préservation des mouvements émotionnels et automatiques. Ce syndrome résulte la plupart du temps d’accidents vasculaires cérébraux consécutifs affectant les opercules. Un tableau clinique inverse, soit une perte sélective des mouvements faciaux émotionnels, a rarement été rapporté et la pathologie sous–jacente est mal localisée.

Cas Clinique:

Nous rapportons un cas de perte sélective des mouvements faciaux émotionnels suite à des infarctus aigus bilatéraux. Aucune étiologie n’a pu être mise en évidence et le syndrome a été réversible.

Discussion:

Une revue de la littérapture et les observations relatives à ce cas clinique suggèrent que les mouvements faciaux volontaires et automatiques empruntent des voies distinctes et que des dommages bilatéraux à l’insula peuvent causer une perte sélective des mouvements faciaux émotionnels. Le tableau clinique de cette dissociation automatique/volontaire inverse doit être reconnu comme un syndrome rare ayant une localisation bilatérale afin que les patients à haut risque d’accidents vasculaires cérébraux subséquents soient identifiés rapidement

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 1 , February 2005 , pp. 119 - 121
Copyright
Copyright © The Canadian Journal of Neurological 2014

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