Isolated body lateropulsion caused by lower lateral medullary infarction

Nakazato, Yoichi; Tamura, Naotoshi; Ikeda, Kei; Yamamoto, Toshiyuki

doi:10.1016/j.ensci.2017.03.004

Cited by 12 publications

(9 citation statements)

References 6 publications

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“…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). The isolated symptomatology of lateropulsion can be attributed to lesions below the network of the vestibulo-ocular reflex (VOR), which links the extraocular eye muscles and contributes to the perception of gravitational vertical.…”

Section: Methods Of Verticality Perceptionmentioning

confidence: 99%

Perception of Verticality and Vestibular Disorders of Balance and Falls

2019

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Objective: To review current knowledge of the perception of verticality, its normal function and disorders. This is based on an integrative graviceptive input from the vertical semicircular canals and the otolith organs. Methods: The special focus is on human psychophysics, neurophysiological and imaging data on the adjustments of subjective visual vertical (SVV) and the subjective postural vertical. Furthermore, examples of mathematical modeling of specific vestibular cell functions for orientation in space in rodents and in patients are briefly presented. Results: Pathological tilts of the SVV in the roll plane are most sensitive and frequent clinical vestibular signs of unilateral lesions extending from the labyrinths via the brainstem and thalamus to the parieto-insular vestibular cortex. Due to crossings of ascending graviceptive fibers, peripheral vestibular and pontomedullary lesions cause ipsilateral tilts of the SVV; ponto-mesencephalic lesions cause contralateral tilts. In contrast, SVV tilts, which are measured in unilateral vestibular lesions at thalamic and cortical levels, have two different characteristic features: (i) they may be ipsi- or contralateral, and (ii) they are smaller than those found in lower brainstem or peripheral lesions. Motor signs such as head tilt and body lateropulsion, components of ocular tilt reaction, are typical for vestibular lesions of the peripheral vestibular organ and the pontomedullary brainstem (vestibular nucleus). They are less frequent in midbrain lesions (interstitial nucleus of Cajal) and rare in cortical lesions. Isolated body lateropulsion is chiefly found in caudal lateral medullary brainstem lesions. Vestibular function in the roll plane and its disorders can be mathematically modeled by an attractor model of angular head velocity cell and head direction cell function. Disorders manifesting with misperception of the body vertical are the pusher syndrome, the progressive supranuclear palsy, or the normal pressure hydrocephalus; they may affect roll and/or pitch plane. Conclusion: Clinical determinations of the SVV are easy and reliable. They indicate acute unilateral vestibular dysfunctions, the causative lesion of which extends from labyrinth to cortex. They allow precise topographical diagnosis of side and level in unilateral brainstem or peripheral vestibular disorders. SVV tilts may coincide with or differ from the perception of body vertical, e.g., in isolated body lateropulsion.

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Section: Methods Of Verticality Perceptionmentioning

confidence: 99%

Perception of Verticality and Vestibular Disorders of Balance and Falls

2019

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“…[ 2 11 12 ] IBL, i.e., BL without other signs of cerebellar or bulbar involvement, has been described in limited case reports where it has been associated with lesions involving the cerebellum,[ 13 14 ] cerebellar peduncles,[ 15 ] red nucleus,[ 16 ] and medulla. [ 5 6 7 17 ] In a few other cases caused by a bulbar lesion, IBL has been reported as an initial symptom of LMS [ Table 1 ]. [ 3 4 5 6 7 18 19 20 ] However, in all cases of BL of bulbar origin, the lesion was found in the ipsilateral part of the medulla [ Table 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] Body lateropulsion (BL), i.e., the phenomenon of tilting the body to one side when standing, may rarely be the initial or unique symptom of LMS, a syndrome that includes a variety of symptoms depending on the extent of the lesion. [ 2 3 4 5 6 7 ] In this study, we report a case of isolated BL (IBL) associated with an acute ischemic infarction in the lateral aspect of the medulla extending from the rostral to the caudal level.…”

Section: Introductionmentioning

confidence: 99%

Isolated axial lateropulsion caused by an acute lateral medullary infarction involving the dorsal spinocerebellar tract: A case report

Sparaco

Apice

et al. 2022

Brain Circ

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Lateral medullary syndrome encompasses a broad spectrum of symptoms and signs depending on the bulbar localization of the lesion. Body lateropulsion (BL) can occur without vestibular and cerebellar symptoms, as a unique manifestation of a lateral medullary infarction. However, it is relatively rare and challenging to diagnose. We report a case of a 72-year-old woman who presented with a tendency to fall to the right. She denied having vertigo, cerebellar signs, sensory loss, or motor weakness. No signs of vestibular dysfunction were found on the ENT examination. Neurological evaluation was unremarkable, except for mild ataxia of the right limbs along with BL to the right side when standing and walking. Brain magnetic resonance (MR) imaging showed an acute small infarct in the right lateral aspect of the medulla extending from the rostral to the caudal level. MR angiography found no stenosis or vascular occlusions. We believe that ipsilateral axial lateropulsion shown by our patient may be related to a selective ischemic lesion of the dorsal spinocerebellar tract in its medullary course. A lateral medullary infarction should be seriously considered in patients who present with isolated BL without further signs of bulbar involvement.

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“…Our patient's predominant symptom was body lateropulsion. The dorsal/ventral spinocerebellar tract, the descending lateral vestibulospinal tract (LVST), the vestibulo-thalamic pathway (ascending graviceptive pathway), the dentatoruburothalamic pathway, and the thalamocortical fascicle play important roles in the maintenance of body posture and stability, and a lesion affecting these pathways can cause body lateropulsion [ 7 , 8 ]. In particular, injuries of the spinocerebellar tract and/or the LVST are known to cause body lateropulsion in patients with lateral medullary infarction or cerebellar infarction [ 1 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

A Report of a Case Involving Body Lateropulsion with Numbness of the Ipsilesional Fingers Caused by a Small Infarction in the Dorsal Part of the Middle Medulla

Yamaoka¹,

Kishishita²,

Takayama³

et al. 2018

Case Rep Neurol

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Based on the complexity of functional anatomy, a small infarction in the medulla can produce various types of clinical symptoms or signs depending on the location of this infarction. We describe the case of a 46-year-old man who presented with sudden onset of body lateropulsion to the left side and numbness of the ipsilateral fingers. 3-tesla diffusion-weighted magnetic resonance imaging with a section thickness of 2 mm revealed a small infarction in the dorsal part of the left middle medulla. To our knowledge, this is the first case report describing vestibular dysfunction apparent upon otoelectrophysiological examination but without vestibular symptoms or signs except for body lateropulsion.

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Isolated body lateropulsion caused by lower lateral medullary infarction

Cited by 12 publications

References 6 publications

Perception of Verticality and Vestibular Disorders of Balance and Falls

Perception of Verticality and Vestibular Disorders of Balance and Falls

Isolated axial lateropulsion caused by an acute lateral medullary infarction involving the dorsal spinocerebellar tract: A case report

A Report of a Case Involving Body Lateropulsion with Numbness of the Ipsilesional Fingers Caused by a Small Infarction in the Dorsal Part of the Middle Medulla

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