John Libbey Eurotext

Epileptic Disorders

The Educational Journal of the

Brainstem lesion causing paroxysmal ataxia, dysarthria, diplopia and hemifacial spasm (PADDHS) Volume 21, numéro 4, August 2019


  • Figure 1
1 Neurology Department, AOR San Carlo, Potenza
2 Neurosciences Department, Niguarda Cà Granda Hospital, Milan
3 Neurorehabilitation Unit, Niguarda Cà Granda Hospital, Milan
4 Neuropsychiatry Unit, IRCCS, Gaslini Institute, Dinogmi, University of Genoa, Italy
* Correspondence: Enrico Ferrante Neurology Department, AOR San Carlo, Potenza, Italy

A 67-year-old man developed paroxysmal ataxia, dysarthria (with a distorted voice that sounded like a 45-rpm record played at 33 rpm), diplopia, and hemifacial spasms (PADDHS) lasting for 15-40 seconds, ∼40 times/day. Ictal video-EEGs did not show paroxysmal discharges. Brain MRI revealed a right-midbrain lesion (figure 1A-C). Inflammatory/autoimmune/neoplastic work-up was normal. The patient took steroid and broad-spectrum antibiotic/antimycotic therapy empirically. PADDHS attacks lasted for [...]