Ataxic Hemiparesis

Abstract

Background and Purpose-Ataxic hemiparesis is a well-recognized lacunar syndrome involving homolateral ataxia with accompanying corticospinal tract impairment. Despite 30 years of clinical experience there continues to be some doubt as to the defining clinical characteristics, precise neuroanatomic localization of the syndrome, and etiologic mechanisms. Methods-We now present 45 new cases that have been analyzed for clinico-radiologic correlation and etiology. Also, all published cases from the English literature known to the authors are reviewed. Results-We found that the clinical syndrome of ataxic hemiparesis accurately predicts a small deep infarction, generally in the pons or internal capsule. Sensory loss is highly associated with a capsular localization. We found that 47% of the cases were attributed to small-vessel disease, 11% to cardioembolism, and only 7% to artery-to-artery embolism (all in the basilar artery); 1 case was attributed to thrombocytosis, 1 to multiple sclerosis, and the rest either had negative or incomplete evaluation. Approximately two thirds of the infarctions occurred in patients with neuroimaging evidence of other ischemic brain lesions. Conclusions-Ataxic hemiparesis is a distinct clinical syndrome that accurately predicts a small deep infarction, most commonly in the pons or internal capsule. Only sensory loss accurately predicts a capsular localization. Etiology in nearly half of the cases can be attributed to small-vessel disease. Furthermore, ataxic hemiparesis appears to be a good marker for generalized asymptomatic cerebrovascular disease. (Stroke. 1998;29:2549-2555.)

Ataxic Hemiparesis From Strategic Frontal White Matter Infarction With Crossed Cerebellar Diaschisis

“…1 In another large series of AH, the infarct localizations were similar (43% pons, 13% internal capsule only, 33% thalamocapsular, and 10% striatocapsular). 2 In another series, the most common infarct locations were internal capsule, pons, and corona radiata. 3 The corona radiata localization of the lacunar infarcts seen in our 3 cases is thus not an uncommon cause of AH.…”

Combination Treatment of Low-Frequency Repetitive Transcranial Magnetic Stimulation and Intensive Occupational Therapy for Ataxic Hemiparesis due to Thalamic Hemorrhage

“…In several subsequent studies [ 4 ], AH was commonly defined as ipsilateral ataxia and hemiparesis without a sensory disturbance. Gorman et al [ 9 ] reported that 45 of 1,468 lacunar infarctions (3%) corresponded to AH, and 10 of those cases (0.7%) were due to a thalamic lesion. However, some patients with a sensory disturbance were also included.…”

Ipsilateral Hemiparesis in a Patient With Existing Contralateral Hemiparesis: A Case Report of a Rare Presentation of Ischemic Stroke

“…These reorganized neurons were impaired in his recent stroke, with the subsequent infarct expansion damaging the original, non-reorganized neurons, that controlled right-sided motor function. These original neurons likely belonged to the CST and intermingled corticocerebellar fibers, leading to his ataxic hemiparesis [10]. Ideally, PET or fMRI could have delineated the exact recovery and pathophysiology of our patient's clinical course [11][12][13]; however, due to resource limitations, this was not feasible.…”