Isolated astasia in acute infarction of the supplementary-motor area

Abstract

Astasia, which is the inability to stand in the absence of motor weakness or marked sensory loss, is an uncommon clinical feature of stroke in the thalamic ventrolateral region. The authors describe a patient with a unilateral supplementary motor area (SMA) infarction presenting with contralateral astasia. On neurological examination, he would lean to the left side and would fall unless supported. He showed no muscle weakness, sensory deficits or cerebellar ataxia. Magnetic resolution imaging of the brain showed acute infarction only involving the right SMA. On the basis of the anatomy that the SMA is connected to the vestibulocerebellar system through the ventrolateral nucleus of the thalamus, the authors concluded that contralateral astasia probably resulted from disruption of this connection following infarction of the SMA.

Isolated astasia caused by a localized infarction in the suprathalamic white matter

“…The authors stated that astasia might be a result from damage to the cingulate gyrus as well as anterior corpus callosum . Wada et al . noted a case of astasia secondary to infarction of the supplementary motor area.…”

“…Astasia designates motor incoordination with inability to stand, despite good strength . Because astasia is a rare symptom, its pathogenesis remains uncertain.…”

“…Because astasia is a rare symptom, its pathogenesis remains uncertain. Regarding responsible region for astasia, the thalamus, thalamo‐mesencephalic junction, mesencephalon, pontomesencephalic locomotor region, posterior cingulate gyrus, and supplementary motor area were reported (Table ). We herein describe a first reported case of isolated astasia due to a suprathalamic white matter infarction.…”

Primary Graviceptive System and Astasia: Case Report and Literature Review

“…It was once recognized as a psychogenic or conversion disorder 27 , however, organic causes have engrossed this term in recent years. Several regions have been reported to be responsible for astasia, including mesencephalon 5,24,32 , thalamus 10,22,25 , suprathalamic white matter 33 , corpus callosum (CC) 37 , cingulate gyrus 16,31,37 , and supplementary motor (SMA) 35 . The causes are not limited to stroke 5,10,16,22,24,25,29,[31][32][33]35,37 , but also tumor 25 , in ammatory disease 36 and hyper-perfusion 18 .…”

Isolated Body Lateropulsion in Supplementary Motor Area Infarction

“…Isolated body lateropulsion (iBL) is a relatively rare neurological deficit that occurs due to lesions in the spinocerebellar tract, descending lateral vestibulospinal tract, vestibulo-thalamic pathway, dentatorubrothalamic pathway, or thalamocortical fascicle ( 1 ). SMA damage is an uncommon cause of iBL, with the impaired connection to the ventrolateral thalamus considered to be responsible ( 2 ). iBL is an infrequent but disabling condition that clinicians should be aware of.…”