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In the course of acute infectious diseases of infancy and early childhood, certain cerebral manifestations, especially those indicating involvement of the motor cortex, are not uncommonly observed. These symptoms have been ascribed to a toxic or a general inflammatory reaction of the cerebral cortex or to a vascular lesion consequent to changes in the blood vessels. The condition has come to be known as acute nonsuppurative encephalitis. The term, unfortunately, does not indicate a specific clinical entity and is not associated with a clearcut pathologic picture. It has been applied to any presumed cerebral lesion in patients presenting the history of acute onset of an infectious state which, early in its course, was accompanied by cerebral symptoms. The most common manifestations in such instances are generalized or localized convulsions, which may or may not be followed by hemiplegia. In some instances, the predisposing infection is known, such as one of the common communicable diseases or an infection of the respiratory passages. A large group of cases exists, however, in which the focus or the nature of the infection has not been determined, and for this reason the cerebral lesion has been designated as primary. It is to this group that we wish to call attention.As neurologists collaborating with physicians in the services of com¬ municable diseases, pediatrics and otology of the Los Angeles County Hospital, we have had the opportunity to study a group of children who presented pronounced unilateral motor manifestations, associated with either an obvious infection of the middle ear or one accompanied by few or no clinical symptoms or signs. At times otitis media was evidently a direct consequence of an acute infectious disease, but in other instances it was apparently primary. It was perhaps the dramatic From the departments

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