Teaching Video Neuro <i>Images</i> : Frontal opercular seizures with jacksonian march

Abstract

A 31-year-old man presented with a 3-month history of progressive dysarthria and 1 month of gradually worsening motor seizures predominantly affecting the right face. Examination was unremarkable except for a mild spastic dysarthria and slow, alternating tongue movements, probably due to a partial opercular syndrome. Seizures captured during EEG recording showed a jacksonian march starting over the opercular aspect of the motor homunculus,1,2 and anarthria and sialorrhea without EEG correlate (videos 1 and 2 on the Neurology ® Web site at Neurology.org and figure 1). MRI brain showed a left opercular tumor (figure 2, A and B), found to be an anaplastic astrocytoma after resection. The patient has been seizure free for 12 months after treatment with carbamazepine and resective surgery but has residual dysarthria.