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To the Editor:
Kumral et al.1 recently described the clinical manifestations of 11 patients with strokes in the subinsular territory. Eight (73%) had facial paresis, but it is not clear from the report whether there was automatic-voluntary dissociation as can be seen with insular and anterior opercular infarcts. Were volitional, emotional, and automatic facial movements similarly affected in these patients?
The authors note that dysphagia and anarthria can be seen in bilateral cortical lesions involving the insular cortex as described by Foix, Chavany, and Marie in 1926.2–4 The anterior opercular syndrome (Foix-Chavany-Marie syndrome or facio-pharyngo-glosso-masticatory diplegia) is characterized by bilateral voluntary central pseudobulbar paresis of …
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