It has been suggested that primary traumatic lesions of the brainstem do not occur in the absence of widespread injury to other parts of the brain. We describe a patient who suffered a severe head injury that left him with paralysis of three extremities and weakness in the fourth. Intellectual function was entirely preserved. Neuropathological examination 39 years after the injury disclosed the presence of a cavitary lesion within the basis pontis. There was no pathological evidence of traumatic injury to any other part of the central nervous system.