A 55-year-old woman presented with motor difficulties in the right arm and leg. She had a history of occipital headache and migraine; MRI of the brain 12 years earlier demonstrated an asymptomatic cavernous malformation in the tegmentum pontis, close to the left superior cerebellar peduncle (SCP) (Fig. 1a). She had marked difficulties with gait and handwriting. On clinical examination, irregular step length and decreased synkinesis were observed. The finger-to-nose test and finger tracking were atactic. She had right-sided limb ataxia, dysmetria and dysarthria.
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