The opercular syndrome is due to bilateral, and sometimes unilateral, lesions of this area of the cerebral cortex, or its connections with the brain stem. The symptoms and signs of the syndrome are described, especially the type of facial palsy. They differ slightly in childhood, and may be accompanied by developmental delay. They can be reversible when linked to epileptic activity in the opercular areas. The symptoms can be suggestive of two well-established syndromes in childhood. Firstly, the Landau–Kleffner syndrome (and there may well be shared pathophysiological mechanisms) and secondly, those first described by Worster–Drought.
The investigations needed to establish the location and the possible causes of the opercular syndrome are discussed. The most common causes are vascular lesions, but other possibilities such as infections and trauma have to be considered. Also malformations of prenatal origin can result in the suprabulbar palsy so typical of the syndrome. If the cause can be established there is always the possibility of treatment.
