Pontine hemorrhage presenting as ataxic hemiparesis.

Abstract

picture has been some­ what modified since the advent of CT scanning.3 Case reports have documented submassive pontine hem­ orrhage with partial to complete recovery. These have included pure motor hemiparesis,4 quadriplegia with bilateral sixth and seventh nerve palsies with total re­ covery,5 and two cases which presented with ocular bobbing with partial recovery.6 I report a case that presented with ataxic hemiparesis resembling a well known lacunar syndrome. Case Report A 54 year old hypertensive male was admitted with the acute onset of left arm and leg weakness while driving his truck. This was preceded by a dull right occipital headache but no nausea, vomiting, or speech difficulty. Physical examination revealed a blood pres­ sure of 210/135. No ocular or carotid bruits were heard. He was fully alert and oriented and had gaze evoked horizontal nystagmus, moderate left central facial weakness, and mild left hemiparesis arm equal to leg. Finger to nose testing was appropriate in the left arm but on heel-knee-shi n testing in the left leg there was a definite ataxia out of proportion to the mild degree of weakness. No tremor was noted and sensa­ tion was normal. The gait was wide based and ataxic and a left plantar extensor response was elicited. Com­ puted tomography (CT) revealed an area of abnormal high density in the right mid pons consistent with a pontine hemorrhage (fig.) There was no enhancement with contrast medium. Over the ensuing week, his weakness and gait ataxia resolved. When seen six weeks after the onset, he had only minimal left leg ataxia and some difficulty with tandem walking. A second CT scan showed complete resolution of the pontine hemorrhage. Discussion