Isolated axial lateropulsion with ipsilesional subjective visual vertical tilt in caudal lateral medullary infarction

Abstract

The isolated body lateropulsion has been well recognized in caudal lateral medullary infarction and postulated to result from the involvement of ipsilateral dorsal spinocerebellar tract which is known to convey proprioception of trunk and legs. However, there has been no case accompanied by the tilt of the subjective visual vertical in caudal lateral medullary infarction. Recently, it has been suggested that a lesion in the ipsilateral graviceptive vestibulothalamic pathway can lead to alteration of subjective visual vertical without ocular tilt reaction in various brainstem lesions. Here we describe two cases of caudal lateral medullary infarction with ipsilesional body lateropulsion and subjective visual vertical tilt but without limb ataxia or ocular tilt reaction. It could be hypothesized that the ascending graviceptive information from the spinal cord may run adjacent to the dorsal spinocerebellar tract or perception of the visual vertical can be influenced by ascending spinal proprioception.

Perception of Verticality and Vestibular Disorders of Balance and Falls

“…The phenomenon of axial body lateropulsion occurs when the body is pulled toward the lesion side and there is a tendency to fall down. It is a well-recognized transient feature of a lateral medullary syndrome (44–46) and axial body lateropulsion may occur in some patients even without vestibular and cerebellar dysfunctions (isolated body lateropulsion). They suffer from a caudal medullary lesion of the spinocerebellar tract, the descending lateral vestibulospinal tract, the ascending vestibulo-thalamic and dentatorubro-thalamic pathways, or the thalamocortical fascicle (44, 45, 47, 48).…”

“…Despite the thus elicited postural imbalance and the conflicting true vertical, the posture is continuously pushed toward what the central nervous system wrongly computes as being vertical (50). The extent of the damage of vestibular structures can certainly vary; in single cases a combination of isolated axial lateropulsion with only ipsilateral SVV tilts was reported in small caudal medullary lesions (46).…”

Comparison of the Static Balance Ability according to the Subjective Visual Vertical in Healthy Adults

“…The F1 frequency band corresponds to an evaluation of the visual system among sensory functions related to the balance ability, the Many studies have reported that an increased SVV in patients with injury of the central or peripheral vestibular system can be related to the balance dysfunction. 16,22,23,28 Pereira et al 22 reported a correlation between the SVV and postural balance in Parkinson's disease patients. They suggested that patients with an impaired balance ability showed a large deviation of the SVV.…”

“…In contrast, patients with good balance ability reported a small deviation of the SVV. 22 Kim et al 23 reported two patients who showed isolated body lateropulsion due to a lateral medullary infarction. Both patients were associated with impaired subjective vertical values.…”

“…7,[12][13][14][15][16] Many previous studies reported the increasing pattern of SVV and the resulting difference in balance and walking ability in patients with peripherial or central vestibular disorders. 9,14,[20][21][22][23] However, there was no study which reported the effect of increased SVV titl in normal adults on static balance. Therefore, this study examined the difference in static balance function according to the SVV results in healthy young adults.…”