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Putaminal haemorrhage leading to pure motor hemiplegia
1Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India.
Abstract:
Pure motor hemiplegia (PMH) is commonly attributed to lacunar infarction of internal capsule or basis pontis. We report 7 patients of pure motor hemiplegia as a result of small or moderate size putaminal haemorrhage. All the patients had normal median somatosensory evoked potentials. Central Motor Conduction Time (CMCT) to upper limb was not recordable in all 3 patients with complete hemiplegia. Three of seven patients had complete and four had partial recovery. Anterioposterior extension of small or moderate size putaminal haemorrhage seems to spare the medially located sensory fibres in the internal capsule. On the basis of our results, lateral putaminal haemorrhage should be considered in the differential diagnosis of PMH.
Insights
Pure motor hemiplegia (PMH) can result from putaminal hemorrhage, not just internal capsule strokes. This finding suggests lateral putaminal hemorrhage should be considered in diagnosing PMH.
Area of Science:
- Neurology
- Neuroimaging
- Stroke Medicine
Background:
- Pure motor hemiplegia (PMH) is typically linked to lacunar infarcts in the internal capsule or basis pontis.
- The precise etiology of PMH can be complex and requires thorough differential diagnosis.
Purpose of the Study:
- To investigate the role of putaminal hemorrhage as a cause of pure motor hemiplegia.
- To evaluate the clinical and electrophysiological findings in patients with putaminal hemorrhage presenting as PMH.
Main Methods:
- Case series of 7 patients with pure motor hemiplegia attributed to putaminal hemorrhage.
- Assessment included median somatosensory evoked potentials and Central Motor Conduction Time (CMCT).
Main Results:
- All patients exhibited normal median somatosensory evoked potentials.
- Central Motor Conduction Time (CMCT) was unrecordable in patients with complete hemiplegia.
- Three patients achieved complete recovery, while four experienced partial recovery.
Conclusions:
- Small to moderate putaminal hemorrhages can cause pure motor hemiplegia by sparing sensory pathways in the internal capsule.
- Lateral putaminal hemorrhage should be included in the differential diagnosis for pure motor hemiplegia.