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Bilateral frontal and parietal opercular lesions cause a syndrome characterized by paralysis of the masticatory,facial,pharyngeal,and tongue muscles(the anterior opercular syndrome).The anterior opercular syndrome can occur in patients with herpes simplex encephalitis(HSE)but in most of these patients the diagnosis of HSE was not confirmed.We describe the anterior opercular syndrome in four patients with HSE.In two of these patients,the anterior opercular syndrome dominated the clinical picture but in the other two patients it was overshadowed by other manifestations of HSE.The diagnosis of HSE was confirmed by detection of herpes simplex virus(HSV),DNA in the CSF(two patients),culture of the HSV from a brain biopsy(one patient)and elevated HSV antibody titers in the CSF(one patient).Our patients made a partial recovery.Acute onset of weakness of masticatory,facial,pharyngeal and glossal muscles,accompanied by fever, headache and partial motor seizures should suggest HSE. |
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aphonia
drooling
dysphagia
encephalitis
facial weakness
facial weakness,bilateral
gag reflex,depressed
herpes simplex encephalitis
operculum syndrome
operculum syndrome,bilateral
palate,paralysis
tongue,weakness
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