Neuroimaging in stroke and non-stroke pusher patients

Abstract

<jats:p>Pusher behavior (PB) is a disorder of postural control affecting patients with encephalic lesions. This study has aimed to identify the brain substrates that are critical for the occurrence of PB, to analyze the influence of the midline shift (MS) and hemorrhagic stroke volume (HSV) on the severity and prognosis of the PB. We identified 31 pusher patients of a neurological unit, mean age 67.4±11.89, 61.3% male. Additional neurological and functional examinations were assessed. Neuroimaging workup included measurement of the MS, the HSV in patients with hemorrhagic stroke, the analysis of the vascular territory, etiology and side of the lesion. Lesions in the parietal region (p=0.041) and thalamus (p=0.001) were significantly more frequent in PB patients. Neither the MS nor the HSV were correlated with the PB severity or recovery time.</jats:p>

Lesion Localization of Poststroke Lateropulsion

“…Three prior groups have highlighted a possible role of the inferior parietal lobe in lateropulsion. 17,28,29 Using a lesion subtraction method, Johannsen, et al 29 matched patients with and without lateropulsion (based upon the Scale of Contraversive Pushing) from cortical stroke lesions that did not involve the thalamus. Subtraction image analysis of their CT or MRI images revealed that patients with lateropulsion had unique areas of involvement of the left posterior insula, the left superior temporal gyrus, the left inferior parietal lobule and the right postcentral gyrus.…”

New Insights for a Better Understanding of the Pusher Behavior: From Clinical to Neuroimaging Features

“…These interesting findings indicate that the thalamic as well as the extra-thalamic brain structures previously related to the PB contribute to the network controlling upright body posture (Ticini et al, 2009). Most recently, the relationship between neuroimaging data of stroke and non-stroke PB patients and the severity and prognosis of PB was analyzed (Santos-Pontelli et al, 2011). In order to measure the hemorrhage stroke volume (HSV) in patients with hemorrhagic stroke it was used the ABC/2 method (Zazulia et al, 1999) on CT scans of the acute stroke stage.…”

“…In this context, Pedersen et al (Pedersen et al, 1996) and Santos-Pontelli et al (Santos-Pontelli et al, 2011) have indicated a wide range of findings from no visible lesion to massive hemispheric lesions on neuroimaging scans in a large sample of PB patients. In these studies, radiologists and neurologists analyzed computed tomography or magnetic resonance imaging in order to determine the type and location of the encephalic lesions.…”

A Chinese Patient with Pusher Syndrome and Unilateral Spatial Neglect Syndrome

“…14 another study showed that pusher syndrome is related to impairment of sensory pathways results from damage of the posterior limb of the internal capsule; however, this cause has not yet been confirmed. 6 Santos-pontelli et al 15 used neuroimaging scans to locate lesions in the anterior and posterior crus of the internal capsule, thalamus, frontal, temporal and parietal lobes, insula and hemispheric lesions in patients with pusher syndrome. in addition, damage in cortical and subcortical regions, such as the insular cortex and posterior central gyrus, have also been suggested to cause pusher syndrome.…”