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Pontine versus capsular pure motor hemiparesis

Departments of Neurology and Cerebrovascular Disease (Drs. Nighoghossian, Ryvlin. and Trouillas) and Neuroradiology (Drs. Laharotte and Froment), Neurological Hospital, Lyon, France.

We prospectively studied 21 patients with pure motor hemiparesis (PMH). CT showed a capsular lesion consistent with the clinical syndrome in 15 patients (71%) and was repeatedly negative in the remaining six (29%). In all six patients with repeatedly negative CT, MRI showed a pontine paramedian infarct as the notable cause of PMH. Clinical findings could not definitely distinguish between capsular and pontine PMH, but the combination of dysarthria and a history of previous transient gait abnormality or vertigo favored a pontine location. Outcome at 3 months was characterized by persistent, moderate to severe disability in 86% of patients with pontine PMH versus 46% in capsular PMH. Based on MRI and magnetic resonance angiographic findings, the presumed mechanism of pontine ischemic lesions was a lacunar process in most instances (86%).

Address correspondence and reprint requests to Dr. N. Nighoghossian, service de neurologie du Pr Trouillas, Hôpital Neurologique, 59 Bd Pinel, Lyon, 69003, France.

Received February 1, 1993. Accepted for publication in final form March 17, 1993.

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