ANTERIOR OPERCULAR SYNDROME, CAUSED BY HERPES-SIMPLEX ENCEPHALITIS

Bilateral frontal and parietal opercular lesions cause a syndrome char acterized by paralysis of the masticatory, facial, pharyngeal, and ton gue muscles (the anterior opercular syndrome). The anterior opercular syndrome can occur in patients with herpes simplex encephalitis (HSE), but ill most of these patients the diagnosis of HSE was not confirmed . We describe tie anterior opercular syndrome in four patients with HS E. In two of these patients, the anterior opercular syndrome dominated the clinical picture, but in the other two patients it was overshadow ed by other manifestations;ions of HSE. The diagnosis of HSE was confi rmed by detection of herpes simplex virus (HSV) DNA in the CSP (two pa tients), culture of the HSV from a brain biopsy (one patient), and ele vated HSV antibody titers in the CSF (one patient). Our patients made a partial recovery. Acute onset of weakness of masticatory, facial, ph aryngeal, and glossal muscles, accompanied by fever, headache, and par tial motor seizures of the face should suggest HSE.