On the Dissociation of Voluntary and Emotional Innervation in Facial Paresis of Central Origin

Monrad‐Krohn, G. H.

doi:10.1093/brain/47.1.22

Cited by 87 publications

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“…Patients with central facial hemiparesis (the inability to produce a voluntary movement on one side of the central face) produce a bilateral smile in response to a joke, presumedly via undamaged sub-cortical structures involved in the generation of spontaneous emotional expressions [23]. Since the spontaneous smiles in the present study were elicited using a humorous incident, it is likely that the smiles obtained were indeed spontaneous.…”

mentioning

confidence: 68%

Left-sided oral asymmetries in spontaneous but not posed smiles

Wylie

Goodale

1988

Neuropsychologia

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Abstract--To investigate possiblefacial asymmetries during the production of posed and spontaneous smiles, the displacement of various reference points on the mouth were measured as subjects produced both kinds of smiles. Strobe cameras were used in combination with a computerbased analysis to record the smiles of left-and right-handed males and females. The analysis revealed that the left side of the mouth moved more than the right side during spontaneous but not posed smiles, supporting the notion that the right hemisphere may play a special role in emotional expression. This asymmetry was most apparent in left-handed females and right-handed males. These sex and handedness differences are discussed with reference to apparent inconsistencies in previous research on asymmetries in emotional expression.

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confidence: 68%

Left-sided oral asymmetries in spontaneous but not posed smiles

Wylie

Goodale

1988

Neuropsychologia

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“…Among the hallmark features of PD, along with tremor, rigidity, slowness, is a "masked" expressionless face. Monrad-Krohn (1924) was perhaps the first to propose a distinction in the neural circuitry for spontaneous (emotional) versus voluntarily initiated facial expressions. He described five patients who displayed abnormalities of facial expression.…”

Section: Introductionmentioning

confidence: 99%

“…A fifth case showed the exact opposite behavioral pattern and was thought to have a pallidal lesion (basal ganglia) secondary to postencephalitic Parkinson's disease. Based on these clinical observations, Monrad-Krohn (1924) proposed a distinction in the neural circuitry for emotional versus voluntary facial expressions. Namely, unilateral lesions of the frontal motor cortex and classic pyramidal pathways disrupt voluntary movements of the contralateral lower face (i.e., a facial hemiparesis), while leaving spontaneous smiles and other facial emotions unaffected.…”

Section: Introductionmentioning

confidence: 99%

Faces of emotion in Parkinsons disease: Micro-expressivity and bradykinesia during voluntary facial expressions

Bowers

Miller

Bosch

et al. 2006

J. Inter. Neuropsych. Soc.

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In humans, the neural circuitry underlying facial expressions differs, depending on whether facial expressions are spontaneously (i.e., limbic, subcortical) or voluntarily initiated (i.e., frontal cortex). Previous investigators have suggested that the "masked face" of Parkinson's disease involves spontaneous, but not intentional, facial expressions. In contrast, we hypothesized that intentional facial expressions may be slowed (bradykinetic) and involve less movement, in much the same way that other intentional movements are affected by Parkinson's disease. To test this hypothesis, we used sophisticated computer imaging techniques to quantify dynamic facial movement. Relative to controls, Parkinson patients had reduced facial movement (entropy) and were significantly slowed in reaching a peak expression (i.e., bradykinesia). These findings are consistent with the view that the basal ganglia play a role in affecting intentional facial movements. This possibly occurs because of diminished efficiency and/or activation of face representation areas in the frontal cortical regions (i.e., motor, premotor, and supplementary motor area) or because of movement-based suppression secondary to dopaminergic reduction in frontostriatal pathways. Taken together, the characterization of Parkinson's disease as a model system for the neuroanatomic dissociation between voluntary and spontaneous expressions may be unjustified.

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“…In myasthenia gravis and GB syndrome, automaticvoluntary dissociation is lacking in eye and facial movements. Unlike in pseudobulbar palsy, the pathological laughter and emotional ability, partial bipyramidal syndromes with dysarthria, urinary incontinence, frontal lobe release signs are lacking in FCMS [2,6,7].…”

Section: Resultsmentioning

confidence: 99%

“…It proves divergent corticobulbar pathways for voluntary and automatic control of craniofacial muscles [1,2]. Possible hypothesis put forward to support this are [1,7]:…”

Section: Resultsmentioning

confidence: 99%

Bi-opercular Syndrome: A Case Report and Minireview

Praveen-kumar¹,

Pramod²

2014

JCDR

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A 40-year-old right handed healthy man had sudden onset of loss of speech and inability to swallow. He did not have any prior history of similar complaints or seizures. There was no history of headache, fever, vomiting or visual symptoms. He was neither a diabetic nor a hypertensive. He was a chronic smoker and alcoholic. On examination, his pulse was 72 per minute, regular and all peripheral pulses were well felt and BP was 130/80 mm Hg. Neurologically, he was conscious and responding to commands, but, he could not vocalize and he could not protrude his tongue or swallow on comm and [Table/ Fig-1]. However, opening of mouth was noted during yawning and laughing [Table/ Fig-2]. He had bilateral central facial paresis with preserved involuntary facial movements. Jaw jerk, palatal and pharyngeal reflexes were normal. Pronator drift of left upper limb and bilateral brisk deep tendon reflexes with bilateral extensor plantars were noted. Fundi and other examinations were normal. Cardiovascular, respiratory and per-abdomen examinations revealed no abnormality. CT head revealed bilateral perisylvian infarcts . MRI brain and angiography could not be done due to financial constraints. Complete hemogram, renal function tests, serum electrolytes and serum transaminases were normal. ECG and echocardiogram including transesophageal echo were normal. Bilateral carotid and vertebral doppler did not reveal any obstruction or stenosis. Transcranial doppler was normal. Stroke in young workup including serum homocysteine level, collagen vascular profile, APLA antibodies and thrombophilia workup were normal. Serum VDRL and HIV I and II were negative. Fasting lipid profile revealed total cholesterol of 296 mg/dl and LDL cholesterol of 138 mg/dl. He was put on Ryle's tube for feeding. He was started on antiplatelets and statins. A psychiatrist consultation was sought for advice regarding de-addiction. Speech and swallowing assessment was done by the therapist. He has shown no improvement in speech and swallowing at discharge and over 4 weeks follow up. He has been advised regular follow ups. DisCussionThe patient presented here had classical features of bilateral opercular syndrome characterised by cortical pseudo-bulbar paralysis (faciolabio-pharyngo-glosso-masticatory paralysis). A salient aspect of this syndrome is voluntary -automatic dissociation, so that the patient cannot voluntarily smile or cry, not even swallow food but has preserved automatic or emotional movements of those muscles (corneal reflex, threaten reflex, laughing, crying, yawning) [1-6]. Internal medicine SectionOpercular syndrome is a well known but neglected entity and is quite common, but it is difficult for non-neurologists to diagnose this entity because of lack of awareness. Inability to speak and swallow with dissociation of automatic voluntary movements in the affected muscles are the essential features of this syndrome. The aetiology in most of the reported cases is vascular (thrombosis or embolism) involving branches of middle cerebral artery supplying...

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On the Dissociation of Voluntary and Emotional Innervation in Facial Paresis of Central Origin

Cited by 87 publications

References 0 publications

Left-sided oral asymmetries in spontaneous but not posed smiles

Left-sided oral asymmetries in spontaneous but not posed smiles

Faces of emotion in Parkinsons disease: Micro-expressivity and bradykinesia during voluntary facial expressions

Bi-opercular Syndrome: A Case Report and Minireview

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