An elderly man with ataxic hemiparesis, diagnosis is
Correct Answer: Cerebellar hemorrhage
Description: (A) Cerebellar hemorrhage # Ataxic hemiparesis> Fisher initially described and named this syndrome, and it consists of a combination of homolateral ataxia and crural paresis.> The usual clinical features include "weakness of the lower limb, especially the ankle and toes, and a Babinski sign, associated with striking dysmetria of the arm and leg on the same side".> Some of the patients also had transient paresthesias, with a stuttering course of symptoms noted. Fisher later renamed the syndrome "ataxic hemiparesis," meaning any combination of weakness and incoordination, out of proportion to weakness, on the same side of the body.> Ataxic hemiparesis occurs in as many as 18% of case series of lacunar infarctions.> Lesions that simultaneously interrupt pyramidal systems (weakness) and adjoining frontopontocerebellar systems (ataxia) produce ataxic hemiparesis. The corona radiata and the anterior limb of the internal capsule are common sites of injury.> Fisher reported 3 autopsied cases that showed contralateral lacunar infarcts in the upper basis pontis.> CT-based series of patients with ataxic hemiparesis have also shown lesions in the internal capsule (posterior limb), corona radiata, lentiform nucleus, and thalamus.> Overall, no distinct clinical features differentiate lacunar infarctions originating in the capsule from those in the pons.> In addition to small deep infarcts, larger anterior cerebral artery infarcts have been recognized as a cause of ataxic hemiparesis with leg-predominant weakness. Ataxic hemiparesis also has been described in several nonischemic lesions, particularly hemorrhages and tumors.> Overall, improvement occurs within days or weeks & occasionally, the hemiparesis improves and the ataxia remains.
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