To our knowledge, only two cases of arterial aneurysms that were diag¬ nosed and successfully operated on1415 were previously reported in infants younger than 1 year of age. Both aneurysms were centrally located on the right middle cerebral artery. Our case involved a peripheral location of a ruptured aneurysm. This is also one of the youngest patients reported to be operated on successfully for a rup¬ tured intracranial aneurysm. References 1. Nishioka H: Report on the cooperative study of intracranial subarachnoid hemorrhage: Section 7. Part 1: Evaluation of the conservative management of ruptured intracranial aneu- rysms. J Neurosurg 25:574-592, 1966. 2. Patel AN, Richardson AE: Ruptured intracranial aneurysms in the first two decades of life: A study of 58 patients. J Neurosurg 35:571-576, 1971. 3. Dandy WE: Venous abnormalities and angiomas of the brain. Arch Surg 17:715-793, 1928. 4. Dandy WE: Arteriovenous aneurysm of the brain. Arch Surg 17:190-243, 1928. 5. Dandy WE: Intracranial Arterial Aneurysms. Ithaca, NY, Comstock Publishing Co Inc, 1944, vol 8, p 147. 6. Sugar O: Symposium on intracranial vascu- lar abnormalities: Pathological anatomy and angiography of intracranial vascular anomalies. J Neurosurg 8:3-22, 1951. 7. Hodes PJ, Perryman CR, Chamberlain RH: Cerebral angiography. Am J Roentgen 58:543\x=req-\ 583, 1947. 8. Forbus WD: On the origin of miliary aneurysms of the superficial cerebral arteries. Bull Hopkins Hosp 47:239-284, 1930. 9. Shucart WA, Wolpert SM: Intracranial arterial aneurysms in childhood. Am J Dis Child 127:288-293, 1974. 10. Matson DD: Intracranial arterial aneurysms in childhood. J Neurosurg 23:578-580, 1965. 11. Nagae K, Goto I, Ueda K, et al: Familial occurrence of multiple intracranial aneurysms. J Neurosurg 37:364-367, 1972. 12. Mullan S: Experiences with surgical thrombosis of intracranial berry aneurysms and carotid cavernous fistulas. J Neurosurg 41:657-671, 1974. 13. Kandel EI, Peresedov VV: Stereotaxic clipping of arterial aneurysms and arteriovenous malformations. J Neurosurg 46:12-23, 1977. 14. Jones RK, Shearburn EW: Intracranial aneurysm in a four-week-old infant: Diagnosis by angiography and successful operation. J Neurosurg 18:122-124, 1961. 15. Vapalahti PM, Schugk P, Tarkkanen L, et al: Intracranial arterial aneurysm in a threemonth-old infant. J Neurosurg 30:169-171, 1969. Pure Motor Hemiplegia due to Hemorrhage in the Lower Pons Jos\l=e'\M. Gobernado, MD; Antonio R. Fern\l=a`\ndezde Molina, MD; Alberto Gimeno, MD Pure motor hemiplegia is a rare syndrome defined by Fisher and Curry1 as a complete or incomplete paralysis of the face, arm, and leg on one side, unaccompanied by sensory signs, visual defect, dysphasia, or apractognosia. We report an additional case of pure motor hemiplegia due to hemorrhage in the lower pons. REPORT OF A CASE A 45-year-old woman awoke with a sudden occipital headache and weakness of the right limbs on March 3, 1979. During the next two days, her motor deficit developed into a complete paralysis of the right arm and a severe weakness of the right leg. There was no impairment of consciousness, convulsions, diplopia, vertigo, dysphagia, paresthesia, or visual or speech difficulty. Her blood pressure was 210/130 mm Hg and the heart rate was 85 beats per minute. There were no cardiac or carotid bruits. She was alert and oriented and without mental impairment. The visual fields, pupils, and ocular motility were normal. Facial sensation was intact. There was no nystagmus or cerebellar ataxia. No dysar- sparing the face. The muscle stretch eighth day showed complete resolution of the pontine hemorrhage. Six weeks after admission the patient was discharged with only a slight paresis in the right arm. Increased stretch reflexes and hypotonia persisted in the right arm. computerized tomographic (CT) In summary, the patient experi¬ enced the gradual development of a reflexes were greater on the affected side, with extensor plantar response. There was no sensory deficit to touch, pinprick, vibra¬ tion, or joint position. Stereognosis and graphesthesia in the right hand were normal. Forty-eight hours after the stroke, a scan showed a dense white area with a high absorption value in the most anterior left side of the lower pons (Figure). Arterial hypertension was satisfactorily controlled with methyldopa and furose¬ mide. One week later, the patient was able to walk with assistance and to carry out discréte movements of the right upper limb. A second CT scan obtained on the Computerized tomographic scan obtained 48 hours after stroke. Note small hemor¬ rhage in most anterior left side of lower pons. COMMENT right flaccid hemiplegia over a period of two days. The arm was more affected than the leg, while the face was spared. No sensory deficit was found. Recovery was satisfactory within six weeks. The clinical signs were consistent with the definition of pure motor hemiplegia.1 Successive CT scans showed resolu¬ tion of the hemorrhage after one week. As far as we know, the present case is the first description of a pure motor hemiplegia secondary to lower pon¬ tine hemorrhage. Diagnosis was possi¬ ble due to CT scan. tbria, diplopia, or palatal or lingual paresis noted. The patient had a right-sided flaccid hemiplegia, worse in the arm, and Nonproprietary Name and Trademark of Drug was Methyldopa-;!'f/omef. Accepted for publication Oct 23, 1979. From the Neurology Service, Ram\l=o'\ny Cajal Center, Madrid. Reprint requests to Servicio de Neurologia, Centro Ram\l=o'\ny Cajal, Carret de Colmenar, Km 9,100, Madrid 35, Spain (Dr Gobernado). Reference 1. Fisher CM, Curry HB: Pure motor hemiplegia of vascular origin. Arch Neurol 13:30-44, 1965. Downloaded From: http://archneur.jamanetwork.com/ by a University of Arizona Health Sciences Library User on 06/07/2015