Infantile Hemiplegia

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Abstract
The author discusses the management of spastic hemiparesis occuring in the early months or years of life, associated with epilepsy and behavior disorders including mental changes and temper tantrums. Emphasis is placed on the removal of the entire cerebral hemisphere of the side opposite that of the hemiplegia. The patients have been studied by a panel of specialists before and after the operation. During the operation the exposed cortex showed different abnormalities, the most common being cystic degeneration around the Sylvian fissure involving the temporal lobe extensively and the parietal lobe to a lesser degree. Around the cystic area the convolutions were narrow and irregular. The frontal lobe was removed first, followed by the parieto-occipito-temporal lobes in a single mass. This left behind the caudate nucleus, optic thalamus and hippocampus. The choroid plexus was excised. Patients responded verbally within a few min. after the operation. The study included 18 patients. The operation eliminated or greatly diminished the epilepsy and removed entirely the behavior disorder. Homonymous hemianopia was produced. Power and sensation were minimally influenced. No immediate post-operative deaths occurred.

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