Acute hemiplegia of childhood.

Acute hemiplegia of obscure cause occurred in 28 children: 13 had had prolonged seizures and a high temperature (considered to have been the direct cause of the brain damage); 5 had had brief seizures, a lower temperature and a depressed level of consciousness; and 10 had a nonfebrile onset of hemiplegia and were found to have vascular abnormalities. Most of the first group were retarded and epileptic at long-term follow-up, as were about half of the second group, whereas children in the third group were of normal intelligence and epilepsy was uncommon among them. Hemiplegia persisted at follow-up in most of the children in each group, the proportion being at least in the third group; if cerebral angiography had demonstrated carotid stenosis or occlusion there was usually poor recovery from the hemiplegia. Bilateral changes on plain skull films or pneumoencephalograms were associated with mental retardation. Failure to control prolonged seizures accompanied by a high temperature predisposes to brain damage; therefore, early and vigorous management is essential.