Paraplegia and focal brain lesions

Paraparesis and paraplegia may be an unusual clinical manifestation of various intracranial disorders. Diffuse brain pathologies, such as multi-infarct encephalopathy and demyelinating or degenerative diseases, and chronic hydrocephalus may often cause motor involvement on both legs; on the other hand, paraplegia is rare or even exceptional in patients with focal brain lesions such as aneurysms, arteriovenous malformations, focal brain infarction, subdural hematoma and intracranial tumors. The present paper reports 7 cases with paraparesis or paraplegia and focal intracranial lesions, including one with anterior communicating artery aneurysm, one with intracerebral hemorrhage, one with anterior cerebral artery ischemia, one with bilateral subdural hematoma and 2 with parasagittal or falx meningiomas. The pathogenetic mechanisms of paraplegia in focal brain pathologies include presence of ischemic lacunae or hemorrhagic foci in both high frontoparietal regions, and simultaneous compression of both right and left paracentral areas or pyramidal tracts. The frequency of paraplegia associated with focal brain lesions and the clinico-radiological diagnostic problems are also discussed.