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Acute hemiplegia in childhood has many causes. Many are vascular, some follow trauma or a variety of encephalitides. Carotid and other basal vascular occlusions may result from cardiac emboli, angiomata, small vessel disease, or in some cases from an arteritis.1 Most children who begin with prolonged focal or generalised epilepsy are left with significant motor deficits, hyperkinetic behaviour, and many with recurrent fits and cognitive defects.
Little was written about the natural history until the 1960s.2–3 Sigmund Freud gave a good description4 in 1897, which like many of his neurological studies at the Salpêtrière is commonly forgotten.5–6
“A previously healthy child without hereditary predisposition suddenly became ill from a few months to 3 years of age. The aetiology of the illness remains unknown or is sought in a simultaneously occurring infectious disease. The initial symptoms may be violent, with fever, convulsions, or vomiting, or may be slight and insignificant . . . speech impediment and aphasia are frequent and usually temporary;
hemianopsia and paralysis of the eye muscles is rare . . . mental disturbance of varied degree is usually apparent. Sooner or later, after the onset of the disease, epileptic seizures occur.”
Freud also here portrayed the bony hypertrophy of the frontal bone and orbits associated with the subsequent cerebral atrophy (the Dyke-Davidoff-Masson skull described in 1933).
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