A CASE is reported of recurrent hemorrhage into the left cerebral peduncle, with adjacent pressure on the cerebral aqueduct, culminating in an acute surgical emergency. An operative approach, with successful evacuation of the hemorrhagic clot from the peduncle, is described. At the time of this report, seven years and three months later, the patient was leading a normal life, with minimal residual symptoms.
Intrapeduncular hemorrhage is not uncommon. The resulting clinical syndromes have been named after Weber, Millard-Gubler, Gruber, Benedict and Parinaud. The onset is frequently sudden, and the results are serious. If the hemorrhage is large, death is immediate; if the hemorrhage is small, the adjacent edema subsides, and there is delayed incomplete recovery with permanent residual disability.1a
The peduncle is roughly trapezoidal, its two sides representing the two peduncles, its dorsal top the tegmentum and its ventral base the basilar portion. The aqueduct pierces the center of