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Opercular syndrome due to non-convulsive status epilepticus in an adult
  1. B Steiner-Birmanns1,
  2. G Munter2,
  3. Y Benasouli3,
  4. B Perl4,
  5. M Itzchaki5,
  6. I Korn Lubetzki6
  1. 1Department of Neurology, Shaare Zedek Medical Center, Jerusalem, Israel
  2. 2Department of Internal Medicine A, Shaare Zedek Medical Center
  3. 3Department of Neurology, Shaare Zedek Medical Center
  4. 4Department of Emergency Medicine, Shaare Zedek Medical Center
  5. 5Department of Orthopedic Surgery, Shaare Zedek Medical Center
  6. 6Department of Neurology, Shaare Zedek Medical Center
  1. Correspondence to:
 Dr B Steiner-Birmanns
 Department of Neurology, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 94342, Israel; bbirmanns{at}szmc.org.il

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The Foix–Chavany–Marie opercular syndrome (FCMS), a severe form of pseudobulbar palsy due to bilateral anterior opercular lesions, may be congenital or acquired, persistent or intermittent.1 FCMS due to epilepsy has been described nearly exclusively in childhood.1 We report the case of an adult patient in whom non-convulsive status epilepticus (NCSE) manifested with opercular syndrome, and which was completely reversible with treatment for epilepsy.

CASE REPORT

A 55-year-old patient with chronic renal failure on haemodialysis was admitted to the orthopaedic surgery department for the treatment of a bilateral humerus fracture. Cognitive and mental functions of the patient were normal before admission. She started to receive oxycodone–acetaminophen four times a day and later oxycodone 10 mg twice a day (total dose of oxycodone 60 mg over 48 h) for pain control. Over the course of 3 days she became confused and later obtunded. Oxycodone was discontinued. She became more alert and was able to communicate with gestures. Neurological examination, however, showed anarthria and inability to swallow, chew, or move her lips and tongue on command. Comprehension was retained during the whole episode, a fact that was proved after recovery, as the patient remembered specific details and events …

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