Postictal cerebral hemiatrophy: with a contribution to the problem of crossed cerebellar atrophy

A case is presented of a 4.5-year-old child who died 5 days after the onset of a continuous hemiconvulsion and compared with three cases of established cerebral hemiatrophy. The laminar necrosis in the first case was strikingly similar in severity and distribution with the laminar cell loss in the others, thus producing additional evidence in support of the postictal aetiology of diffuse cerebral hemiatrophy. Particular attention was focussed on the pontocerebellar lesions. Three types of lesions were observed in the ipsilateral nuclei pontis: (1) focal neuronal necrosis in the acute stage, (2) focal neuronal loss, presumably the end result of the preceding lesion and (3) transneuronal atrophy. The contralateral cerebellar hemisphere showed the following abnormalities, singly or in combination: (1) necrosis of Purkinje cells in the acute stage, (2) loss of Purkinje cells and lobular sclerosis in advanced cases and (3) reduction in bulk of the hemisphere due to lesions in the nuclei pontis and degeneration of pontocerebellar fibres. These findings of the so-called crossed cerebellar atrophy.