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October 1983

Homolateral Ataxia and Crural Paresis-Reply

Author Affiliations

Neurology Service Massachusetts General Hospital Fruit Street Boston, MA 02114

Arch Neurol. 1983;40(10):660. doi:10.1001/archneur.1983.04050090096024

In Reply.  —More cases with homolateral ataxia and crural paresis are accumulating, and Dr Jacome's suggestion that the responsible lesion lies in the posterior limb of the internal capsule may be correct. At the Massachusetts General Hospital in Boston, we have still not encountered such a case. In one instance, CT showed a low-density area in the region of the posterior limb of the contralateral internal capsule, but nuclear magnetic resonance (NMR) demonstrated another lesion in the contralateral pons. In another case with mainly leg involvement, the lesion found at autopsy was in the pons. Thus, the clinical-CT correlation is not necessarily straightforward. It is important that pathologic confirmation be obtained. Computed tomography is generally unsatisfactory for the detection of small pontine infarcts; a slight tilt to the head to make the temporal bones asymmetrical improves the image of the pons. Nuclear magnetic resonance promises to be much superior to CT in

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