Search

th cranial nerves. The so-called "automatic-voluntary dissociation" can be elucidated by analysis of functional neuro-anatomy. Volitional control of the facial, oral and pharyngeal musculature demands intact motor cortices and pyramidal pathways; pathology in these areas leads to a selective palsy of voluntary use of these muscle groups. Emotional or spontaneous use of these muscle groups however require intact extrapyramidal pathways as well as parts of the hypothalamus and thalamus, thus explaining the dissociation between automatic and voluntary move- ments. Some reports have also been made of patients with bilateral opercular syndrome who presented with only a unilateral lesion; it is believed that an occult underlying lesion on the contralateral side would account for these manifestations. Imaging thus plays an important role in detection of opercular lesions, most frequently by detection of recent stroke (by way of diffusion weighted imaging), allowing adequate management.