Homolateral ataxia and crural paresis: A vascular syndrome

156

Background and Purpose: This study evaluated the characteristics and natural history of patients with lacunar (small, deep) cerebral infarcts in a defined population for comparison of these characteristics to those in patients with nonlacunar infarcts.Methods: This is a population-based study in Rochester, Minnesota, from 1960 to 1984, that used the medical record-linkage system to identify and characterize patients with cerebral infarction.Results: The age-and sex-adjusted average annual incidence rate of lacunar cerebral infarction was 13.4/100,000 persons, accounting for 12% of all first cerebral infarcts. Temporal trends in incidence rates, stroke recurrence rates, prevalence of diabetes mellitus, and causes of death (given survival for 30 days) for cases of lacunar infarction were not significantly different from those for cases of nonlacunar infarction. Hypertension was found in 81% of patients who had a lacunar infarct and in 70% of patients who had a nonlacunar infarct (/7=0.05). A potential cardiac source of embolism was found in 12% of patients who had a lacunar infarct and in 28% of patients who had a nonlacunar infarct (p=0.002). Survival was significantly better after a lacunar infarct than after a nonlacunar infarct Conclusions: Small, deep cerebral infarcts had many of the epidemiological characteristics of other cerebral infarcts but there was a slightly higher frequency of hypertension, significantly lower frequency of a cardiac embolic source, and significantly better survival in patients with lacunar infarction than in those with nonlacunar infarction. (Stroke 1991^22:1236-1241)

mentioning

confidence: 99%

Epidemiological characteristics of lacunar infarcts in a population.

Sacco

Whisnant

Broderick

et al. 1991

156

“…1 Initially attributed to infarction localized to the posterior limb of the internal capsule and verified at autopsy by Fisher and Cole, 2 later necropsy-based findings of Fisher 3 and computed tomographic (CT) review by Huang and Lui 4 established that accompanying hemihypesthesia indicated a capsular rather than a pontine location for lesions causing the ataxic hemiparesis symptom complex. Larsen et al 5 recently confirmed the capsular identity of ataxic hemiparesis using magnetic resonance imaging (MRI).…”

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confidence: 99%

Capsular hypesthetic ataxic hemiparesis.

Helgason

Wilbur

1990

Twenty-three patients with hypesthetic ataxic hemiparesis underwent computed tomography or magnetic resonance imaging. Twenty-two patients had infarcts of lacunar or slightly larger size in the contralateral posterior limb of the internal capsule. In 15 patients the infarct extended superiorly into the adjacent paraventricular region, and in seven it extended into the lateral thalmus. In eight patients the infarct was limited to the posterior limb of the internal capsule, and in only two patients was an ipsilateral to capsular pontine lacune found. Despite a location similar to that of pure motor and pure sensory lacunar stroke, hypesthetic ataxic hemiparesis correlates with larger infarcts, most often located in the posterior medial superior territory of the antierior choroidal artery. Some infarcts appeared to be localized immediately posterolateral to this region, in the posterior cerebral artery territory. The presence and extent of infarction is better detected by the addition of magnetic resonance imaging to computed tomography. (Stroke 1990;21:24-33)

“…The interest of the present case is 2-fold: (1) it is the first description of "crossed ataxia"; and (2) it shows that diffusion tensor imaging tractography may help in understanding the functional anatomy of the clinical picture, particularly that of the ipsilesional ataxia, whose origin is often discussed.…”

Section: Discussionmentioning

confidence: 99%

Crossed Ataxia

Bally

Mégevand

Nguyen

et al. 2011

Background and Purpose-Ever since the seminal description of ataxic hemiparesis contralateral to a pontine lesion by Miller-Fisher, the question of why contralesional crossing pontocerebellar fibers do not more frequently produce ipsilesional hemiataxia was raised. The few cases of "quadrataxic hemiparesis" or bilateral leg ataxia remain exceptions. Summary of Case-We report an even more unusual variant, namely "crossed ataxia" of the contralesional arm and the ipsilesional leg subsequent to an anteromedial pontine ischemic stroke. Conclusions-MRI diffusion tensor imaging tractography shows that caudal contralesional crossing pontocerebellar fibers (those for the leg) travel trough the lesion, whereas more rostral fibers (those for the arm) are spared. (Stroke. 2011; 42:e571-e573.)