Bilateral opercular syndrome: an unusual complication of perinatal difficulties

We describe an 8-year-old boy with pseudobulbar palsy and speech disturbance associated with fetal distress, mild birth asphyxia and probably intracranial hemorrhage. There is a remarkable dissociation between orofacial voluntary movements and emotional expression. MRI revealed cortical atrophy and subcortical gliosis of both opercula. The clinical and neuroradiological features correspond to bilateral opercular syndrome. We assume that a reduction of cerebral blood flow involving both opercula induced pseudobulbar palsy with severe expressive speech disturbance.