Lateropulsion and Imbalance in Wallenberg's Syndrome

Bjerver, Kjell; Silfverskiöld, B. P.

doi:10.1111/j.1600-0404.1968.tb07446.x

Cited by 51 publications

(12 citation statements)

References 13 publications

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“…The active pushing away with the nonparetic extremities distinguishes pusher patients from those patients with lateropulsion in Wallenberg's syndrome (23,24). Dieterich and Brandt (24) investigated 36 such patients with acute unilateral medullary brainstem infarctions.…”

Section: Discussionmentioning

confidence: 99%

The neural representation of postural control in humans

Karnath

Ferber

Dichgans

2000

Proc. Natl. Acad. Sci. U.S.A.

144

137

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Lesion of the “vestibular cortex” in the human posterior insula leads to a tilted perception of visual vertical but not to tilted body posture and loss of lateral balance. However, some stroke patients show the reverse pattern. Although their processing of visual and vestibular inputs for orientation perception of the visual world is undisturbed, they push away actively from the ipsilesional side (the side of lesion location), leading to a contraversive tilt of the body (tilt toward the side opposite to the lesion) and falling to that side. Recently, the origin of contraversive pushing was identified as an altered perception of the body's orientation in relation to gravity. These patients experience their body as oriented “upright” when actually tilted enormously to the ipsilesional side (18° on average). The findings argued for a separate pathway in humans for sensing body orientation in relation to gravity apart from the one projecting to the vestibular cortex. The present study aimed at identifying this brain area. The infarcted brain regions of 23 consecutively admitted patients with severe contraversive pushing were projected onto a template MRI scan, which had been normalized to Talairach space. The overlapping area of these infarctions centered on the posterolateral thalamus. Our finding necessitates reinterpretation of this area as being only a “relay structure” of the vestibular pathway on its way from the brainstem to the vestibular cortex. The ventral posterior and lateral posterior nuclei of the posterolateral thalamus (and probably its cortical projections) rather seem to be fundamentally involved in the neural representation of a second graviceptive system in humans decisive for our control of upright body posture.

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Section: Discussionmentioning

confidence: 99%

The neural representation of postural control in humans

Karnath

Ferber

Dichgans

2000

Proc. Natl. Acad. Sci. U.S.A.

144

137

View full text Add to dashboard Cite

show abstract

“…Active pushing away with non-paretic extremities also distinguishes pusher patients from patients with Ôlat-eropulsion', a phenomenon commonly observed in Wallenberg's syndrome [6,21]. Dieterich and Brandt [21] investigated 36 such patients with acute unilateral medullary brainstem infarctions and found that they had lateropulsion (defined as a tendency to fall sideways) with an ipsiversive deviation of the center of gravity (determined by means of posturography), i.e.…”

Section: J Lateropulsionmentioning

confidence: 97%

Pusher Syndrome – a frequent but little-known disturbance of body orientation perception

Karnath

2007

J Neurol

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Disturbances of body orientation perception after brain lesions may specifically relate to only one dimension of space. Stroke patients with "pusher syndrome" suffer from a severe misperception of their body's orientation in the coronal (roll) plane. They experience their body as oriented 'upright' when it is in fact markedly tilted to one side. The patients use the unaffected arm or leg to actively push away from the un-paralyzed side and resist any attempt to passively correct their tilted body posture. Although pusher patients are unable to correctly determine when their own body is oriented in an upright, vertical position, they seem to have no significant difficulty in determining the orientation of the surrounding visual world in relation to their own body. Pusher syndrome is a distinctive clinical disorder occurring characteristically after unilateral left or right brain lesions in the posterior thalamus and -less frequently- in the insula and postcentral gyrus. These structures thus seem to constitute crucial neural substrates controlling human (upright) body orientation in the coronal (roll) plane. A further disturbance of body orientation that predominantly affects a single dimension of space, namely the transverse (yaw) plane, is observed in stroke patients with spatial neglect. Apparently, our brain has evolved separate neural subsystems for perceiving and controlling body orientation in different dimensions of space.

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“…Another difference in these two types of patients is the severity of hemiparesis. 15,16 Patients with pusher syndrome post-stroke have been shown to display an intact perception of subjective visual vertical, indicating that their processing of visual and vestibular inputs for perception and orientation of the visual world is undisturbed. 13 Wallenberg's syndrome can be found in patients with acute unilateral brainstem infarctions in the area of the medulla.…”

Section: Distinguishing Patients With Pusher Syndrome From Patients Wmentioning

confidence: 99%

The ‘Pusher Syndrome’

Roller¹

2004

Journal of Neurologic Physical Therapy

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Pusher syndrome in patients post-stroke is characterized by leaning and active pushing toward the hemiplegic side with no compensation for the instability, and resistance to passive correction toward midline. Patients with pusher syndrome post-stroke have been found to require longer than average to reach independence in activities of daily living and ambulation. This behavior is found to be present primarily in patients with right hemispheric lesions centered in the area of the posterolateral thalamus. Patients with this disorder misperceive body orientation in space, believing that the upright position is approximately 18°t ilted toward the ipsilesional side. This could be the result of 'graviceptive neglect' of signals originating in the contralesional trunk and pelvis. The ability to use visual information for the correction of body posture continues to exist in this population, allowing for the use of visual cues and cognitive strategies as potential rehabilitation tools.

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Lateropulsion and Imbalance in Wallenberg's Syndrome

Cited by 51 publications

References 13 publications

The neural representation of postural control in humans

The neural representation of postural control in humans

Pusher Syndrome – a frequent but little-known disturbance of body orientation perception

The ‘Pusher Syndrome’

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